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This is VAERS ID 122669

Case Details

VAERS ID: 122669 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Unknown  
Vaccinated:1999-04-26
Onset:1999-04-28
   Days after vaccination:2
Submitted: 1999-05-20
   Days after onset:22
Entered: 1999-05-25
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Apnoea, Cardiac arrest, Ecchymosis, Pyrexia, Rash, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-05-02
   Days after onset: 4
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: lt hip dysplasia;otic infection;seizure
Allergies:
Diagnostic Lab Data: bacterial cult (blood/spleen/brain/lungs)=neg;xrays=nl; child had small bruise on head from fall-no evidence of trauma; viral cult (brain/lung/intestine) not avail
CDC Split Type: WAES99050142

Write-up: mo put sunscreen on face day of vax;2 days p/ vax little red dots on upper cheeks, not itchy & T99.3-99.5(ear);4th and 5th day p/ vax, afebrile but out of sorts & wanting to be held more; AM-6th day found dead in bed, COD SIDS, autopsy neg.


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