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This is VAERS ID 150243

Case Details

VAERS ID: 150243 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-03-07
Onset:2000-03-11
   Days after vaccination:4
Submitted: 2000-03-13
   Days after onset:2
Entered: 2000-03-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7388BA / 4 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG314009 / 4 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0548AA / 3 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0473 / 3 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0928J / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Apnoea, Atelectasis, Brain oedema, Convulsion, Foetal disorder, Hyperplasia, Liver disorder, Petechiae, Pulmonary congestion, Pulmonary oedema, Renal disorder, Spleen disorder, Tremor
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Foetal disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy to be performed
CDC Split Type: MS00007

Write-up: No reaction or illness was noted after vaccine until the morning of 3/11/00. The child was playing and then laid down on couch and started shaking and stopped breathing. Autopsy showed cause of death to be consistent with seizure. Other findings of pulmonary vascular congestion and edema, atelectasis of the lungs, hepatic congestion, petechiae of the thymus, splenic congestion, reactive lymphoid hyperplasia of the mesenteric lymph nodes, renal congestion, fetal lobulation of the kidneys, cerebal edema.


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