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This is VAERS ID 106256

Case Details

VAERS ID: 106256 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Texas  
Vaccinated:1997-12-10
Onset:1997-12-14
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1998-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81601 / 3 RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924C / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0465E / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0543E / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Anorexia, Asthenia, Convulsion, Dyspnoea, Hypothermia, Pyrexia, Stupor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-12-19
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE MD recommended vax
Allergies:
Diagnostic Lab Data: parents stated spinal fluid test done-results unk;
CDC Split Type: TX97167

Write-up: pt recv vax 10DEC97 & 14DEC97 elevated temp, poor appetite, weakness;15DEC97 inc temp taken to hosp adm;16DEC97 inc temp convuls, diff breathing taken to hosp;17DEC97 dec temp condition unresponsive & unable to communicate;


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