Teenager Rosey Christoffersen loved football from an early age, with her enthusiasm matched by a talent for scoring goals. She attended regular training sessions and played weekly fixtures with a local club, but became alarmed one season over her rapidly declining fitness.
“I’m gassed,” she would tell her coach at Wallasey Wanderers in Wirral as she struggled with exhaustion, asking to be pulled off at half-time. She was also complaining to her family of pains in her chest.
She had previously been an occasional smoker but had started using flavoured vapes and soon found it a compulsive habit. She was assured by her local GP surgery that the discomfort in her chest was likely to be a pulled muscle.
“She would go into the local shop and buy these vaping liquids but you would never see the same bottle twice,” said Rachel Howe, 45, her mother. “There would be coconut, cherry, bubblegum vapes. It was constantly in her mouth.”
On Valentine’s Day in 2015, she collapsed in the street. Howe said: “A member of the public called me on her phone and said: ‘We’re with your daughter and she’s on the floor. Someone’s rung an ambulance.’
Both of Christoffersen’s lungs had spontaneously collapsed, a condition known as bilateral pneumothorax. By the time she arrived at the nearby Arrowe Park hospital in Birkenhead, she was brain dead.
“I’m always glad I was spared that moment when she fell,” said Howe, who lives in Wirral. “I don’t know how I would have coped with that. When I saw her in hospital, it was like she was sleeping comfortably, but I just knew she wasn’t there.”
Christoffersen’s family faced overwhelming grief, but also a persistent question: how could a healthy teenager suddenly collapse and die?
Her mother asked one of the emergency doctors whether the prolific vaping may have been a factor. “We don’t know what we are dealing with, with e-cigarettes,” he told her. “We’ll know in 10 years’ time the damage we are doing.”
The government is keen to promote e-cigarettes to smokers because the evidence to date indicates they have a “small fraction of the risks” of tobacco. Some doctors warn that rules for the marketing and sale of e-cigarettes in the UK are too lax and say more research is required on the health risks.
The Observer has revealed in investigations into the vaping industry in recent weeks how one of the leading brands is apparently flouting rules to promote vapes to young people on TikTok. Respiratory doctors have also spoken out to warn of “a generation of children hooked on nicotine” and called on the government to urgently overhaul the regulations.
No inquest was held into Christoffersen’s death, and over the years her mother has researched online the links between e-cigarettes and potentially deadly lung conditions. Pneumothorax is a rare condition and can occur in healthy adults, but some doctors are concerned it may be linked to vaping.
The journal Respiratory Medicine Case Reports reported in May last year of a growing association between pneumothorax and e-cigarettes, but said it had not yet been established as a risk factor.
Howe is convinced that vaping was involved in her daughter’s death and wants the government to introduce stricter controls on e-cigarettes to stop them appealing to children and young people. “There needs to be massive research into this,” she said. “In the meantime, they should be treated like tobacco and only sold from a closed cabinet behind a counter.”
Christoffersen, who attended Hilbre high school in West Kirby and City of Liverpool College, had a talent for drama as a student, acting in a stage adaptation of Anthony Burgess’s novel A Clockwork Orange.. Her mother describes her as “a ball of energy, full of fun”. She loved swimming, doted on Liverpool football club and was a regular player for Wallasey Wanderers, winning a local league and cup when she was in the under-14s team.
She started smoking occasionally when she was 16 and began using e-cigarettes in September 2014, a few months before her death.
Her mother said: “All of her friends were vaping. I hated it because she was on it all the time. I believe she became more addicted to vaping than she was ever addicted to cigarettes. She started having chest pains and having a bit of trouble breathing.”
Howe said she thought the vaping was likely to be the cause but did not consider her daughter would possibly be at risk of a sudden death.
A week after Christoffersen collapsed, her life support was turned off. Her mother was at her bedside as her life ebbed away. “I told her to swim, because she loves swimming. She was a little fish. And I asked them to open the window, and these shafts of sunlight came through and shone right on her.”
Christoffersen died on 21 February 2015, three days before her 19th birthday. She had told her mother the previous week that she wanted her organs to be donated to save lives. She donated her kidneys, liver, skin grafts, the valves from her heart, and bone for facial reconstruction.
“I found out afterwards all the people she had helped, and one lady even wrote to me who got her liver,” said Howe. “My daughter died and helped save eight people. It’s amazing.”
She now hopes another legacy of her daughter will be a warning that e-cigarettes are not risk-free. “I see kids vaping and I go and tell them that I believe my daughter died from e-cigarettes,” she said.
Professor Andrew Bush, a consultant paediatric chest physician at Royal Brompton and Harefield hospitalsand director of Imperial College London’s Centre for Paediatrics and Child Health, said he was extremely concerned about the potential adverse health effects of e-cigarettes, and there were cases of acute lung injury associated with their use from around the world.
He said: “The legislators should be taking this seriously and treating e-cigarettes like tobacco in terms of the advertising and plain packaging.”
A safety review by the Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment concluded that the risk of adverse health effects from vaping products is expected to be much lower than from cigarettes. The review found that exposure to particulate matter and nicotine could be associated with adverse health effects and that the effects of inhaling flavouring ingredients is uncertain.
Between May 2016 and January 2021 the Medicines and Healthcare products Regulatory Agency in the UK received 231 reports of 618 adverse reactions believed to be associated with vaping product. Since May 2016 there have been three deaths in the UK linked with vaping products.
Wirral University teaching hospital NHS foundation trust, which includes Arrowe Park hospital, said an initial check of its records did not indicate Christoffersen’s death was reported to the coroner.
It said it was not possible to conduct more detailed checks on the case in the time available.
