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This is VAERS ID 485004

Case Details

VAERS ID: 485004 (history)  
Form: Version 1.0  
Age: 1.86  
Sex: Female  
Location: Utah  
Vaccinated:2013-01-21
Onset:2013-01-28
   Days after vaccination:7
Submitted: 2013-02-20
   Days after onset:23
Entered: 2013-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U4547CA / 1 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0532AE / 2 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Death, Influenza A virus test positive, Laboratory test, Respiratory arrest, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2013-01-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PMD''s office reported that child had been recommended to take a multivitamin, unknown if child was taking.
Current Illness: None reported by PMD''s office
Preexisting Conditions: None reported by PMD''s office
Allergies:
Diagnostic Lab Data: Child had been seen at Emergency Room on 01/27/2013 and had positive rapid influenza A testing. No influenza testing through second Medical Center but did have series of testing to determine cardiac related event. Autopsy was declined by family.
CDC Split Type:

Write-up: Per hospital and family reports, child was talking to grandfather when she collapsed and stopped breathing. Grandfather performed CPR until EMS arrived and child was transported via AirMed to Medical Center. Child expired on 01/30/2013.


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