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This is VAERS ID 133895

Case Details

VAERS ID: 133895 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2000-01-25
Onset:2000-02-01
   Days after vaccination:7
Submitted: 2000-02-04
   Days after onset:3
Entered: 2000-02-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 466022 / 5 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12755 / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 80045 / 4 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Encephalopathy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Montoux, Parker (mfr), 250611 (Lot) ID/LForearm, 1 previous dose
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 wk post vax, pt devel severe fatal encephalopathy.


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