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This is VAERS ID 116569

Case Details

VAERS ID: 116569 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Foreign  
Vaccinated:1998-11-09
Onset:1998-11-09
   Days after vaccination:0
Submitted: 1998-11-17
   Days after onset:8
Entered: 1998-11-20
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 111011A / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardiac failure, Cardiovascular disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: aortic valve stenosis
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: WAES98110919

Write-up: pt recv vax 9NOV98 & 3hr post vax pt exp sudden death;DOC unk;


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