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This is VAERS ID 494024

Case Details

VAERS ID: 494024 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-01-25
Onset:2012-01-25
   Days after vaccination:0
Submitted: 2013-06-12
   Days after onset:503
Entered: 2013-06-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4032AA / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Cerebral haemorrhage, Coma, Death, Haematemesis, Injection site bruising, Leukaemia, Oropharyngeal pain, Pyrexia, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-02-10
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 1/25/2012, as per mother patient developed a black bruise to the left upper arm where vaccines had been administered that covered most of the entire upper arm. On February 1, 2012, he developed a sore throat and fever that lasted a week. On February 7, 2012 at 11 am he reported to hospital. As per mother, patient was non-responsive and was throwing up blood-tinged saliva. He was flown out due to an internal hemorrhage. He was admitted to hospital at around 3 pm. After admission, he remained unresponsive. As per mother, the internal cerebral hemorrhage was too advanced and the patient was not a candidate for surgery so patient eventually became comatose. He passed away on 2/10/2012 at 2 am. Final diagnosis was cerebral hemorrhage and leukemia. As per parent, the client had no previous history of illnesses at the time of vaccination on 1/25/2012.


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