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This is VAERS ID 112819

Case Details

VAERS ID: 112819 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Michigan  
Vaccinated:1998-07-06
Onset:1998-07-13
   Days after vaccination:7
Submitted: 1998-07-20
   Days after onset:7
Entered: 1998-07-23
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1316E / 1 - / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0650H / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: No relevant data;~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux;anoxic brain damage;apnea;mental retardation;micrencephaly;premature delivery;sz;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98070941

Write-up: pt recv vax 6JUL98 & 12JUL98 pt was put to bed & was nl prior to bedtime;13JUL98 pt was found dead;the reporting nurse noted that the pt did not have any fever or resp problems noted @ bedtime;no autopsy was ordered per family request;


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