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This is VAERS ID 123218

Case Details

VAERS ID: 123218 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Oregon  
Vaccinated:1999-04-10
Onset:1999-04-30
   Days after vaccination:20
Submitted: 1999-05-21
   Days after onset:21
Entered: 1999-06-02
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0961040 / 4 RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0957700 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1980H / 1 LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Lymphocytosis, Pancytopenia, Pyrexia, Red blood cell abnormality
SMQs:, Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: pt sibling had similar illness w/death p/vax in Romania 14yr ago @ 7mo~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: bone marrow, serum ferritin, pancytopenia
CDC Split Type:

Write-up: hemophagocytic lymphohistiocytosis (HLH) on 4/30/99, 20 days p/vax;studies including bone marrow @ hosp revealed dx on 9th day of fever;pt on chemotherapy awaiting marrow transplant;viral infect, including varicella vax are known triggers


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