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This is VAERS ID 127043

Case Details

VAERS ID: 127043 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:1998-10-07
Onset:1998-12-21
   Days after vaccination:75
Submitted: 1999-08-02
   Days after onset:223
Entered: 1999-08-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1004H / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0845H / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Oesophageal stenosis, Pneumonia aspiration
SMQs:, Gastrointestinal obstruction (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-12-21
   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: Iron drops; albuterol PRN; Synagis every mo, 11/11 & 12/8/98 MFR Medimmune, lot# 808047
Current Illness: NONE
Preexisting Conditions: TE fistula, CP, prematurity, hyaline membrane disease, spit fistula, aspiration, G tube
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death; autopsy performed by county; aspiration pneumonia;


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