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This is VAERS ID 116616

Case Details

VAERS ID: 116616 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Vermont  
Vaccinated:1998-10-07
Onset:1998-10-16
   Days after vaccination:9
Submitted: 1998-11-16
   Days after onset:31
Entered: 1998-11-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785H / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0644H / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hydronephrosis, Hypoxia, Pericardial effusion, Pulmonary oedema, Renal impairment, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: adopted child-birth parents siblings;hydronephrosis & renal insuff on autopsy
Allergies:
Diagnostic Lab Data: autopsy unrevealing of COD
CDC Split Type:

Write-up: unexplained infant death;autopsy finding of hydronephrosis & renal insufficiency not felt to be r/t pt death;


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