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This is VAERS ID 121425

Case Details

VAERS ID: 121425 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Georgia  
Vaccinated:1999-03-11
Onset:1999-04-02
   Days after vaccination:22
Submitted: 1999-04-09
   Days after onset:6
Entered: 1999-04-23
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792A / 3 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1252H / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Dehydration, Gastroenteritis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Noninfectious diarrhoea (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-04-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: GA99033

Write-up: None reported to this facility;


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