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This is VAERS ID 152670

Case Details

VAERS ID: 152670 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-05-15
Onset:2000-05-25
   Days after vaccination:10
Submitted: 2000-05-30
   Days after onset:5
Entered: 2000-06-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1275J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Atelectasis, Brain oedema, Liver disorder, Pallor, Pharyngitis, Pneumonia, Pulmonary congestion, Pyrexia, Rash macular, Respiratory failure, Rhinitis
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-28
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD - Lot number 0090P, ID, RA
Current Illness: NONE
Preexisting Conditions: febrile seizures, pneumococcal bacteremia
Allergies:
Diagnostic Lab Data: CBC-5500
CDC Split Type:

Write-up: on 5/25/00, pt had fever, cold symptoms for 2 days, runny nose, red pharynx, a few papules on face, WBC 5,500. 5/27 via phone call, pt was pale, had macular rash on nose and face, fever was 100.8. Pt was taken to ER on 5/28. DOA, (probably several hours). Autopsy states liver congestion, lung atelectasis, lung congestion, respiratory failure due to streptococcal (group B) pneumonia, ceberal edema,


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