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This is VAERS ID 459641

Case Details

VAERS ID: 459641 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
Vaccinated:2012-01-19
Onset:2012-01-28
   Days after vaccination:9
Submitted: 2012-07-13
   Days after onset:166
Entered: 2012-07-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Congestive cardiomyopathy, Death, Excessive exercise, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-01-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC Split Type:

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.


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