National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 150875

Case Details

VAERS ID: 150875 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Indiana  
Vaccinated:1999-08-27
Onset:1999-09-01
   Days after vaccination:5
Submitted: 2000-03-06
   Days after onset:187
Entered: 2000-04-10
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0970140 / 5 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1552H / 2 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798L / 4 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-09-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mantoux-TB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report revealed the cause of death to be subacute myocardititis with heart failure.
CDC Split Type:

Write-up: September 1, 1999, woke at 2:00 AM with fever. Had diarrhea at 13:30 PM and threw up at 15:00 PM. Gave Tylenol for fever. Passed away during the night. Pronounced dead on September 2, 1999.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=150875


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166