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This is VAERS ID 165974

Case Details

VAERS ID: 165974 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Florida  
Vaccinated:2001-01-16
Onset:2001-01-23
   Days after vaccination:7
Submitted: 2001-02-14
   Days after onset:22
Entered: 2001-02-20
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Encephalitis, Immune system disorder
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: failure to thrive, immunodeficiency
Allergies:
Diagnostic Lab Data: spinal tap - pending
CDC Split Type: WAES01020506

Write-up: Information has been received from a physician concerning a 14 month old female with failure to thrive and possible immunodeficiency who on approx. 1/16/01, was vaccinated with MMR II. On approx. 1/23/01, the pt experienced encephalitis, seizures and immune deficiency (that could have possibly been present prior to vaccination). The encephalitis, seizures and immune deficiency required hospitalization. At the time of the report (2/6/01), a spinal tap was pending. The pt''s hospitalization continued and the pt was noted to be in poor condition. Additional information has been requested. Follow-up states the pt has died.


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