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This is VAERS ID 169360

Case Details

VAERS ID: 169360 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2000-09-08
Onset:2000-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2001-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R12901 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0406K / 2 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-12
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Seizures~Measles + Mumps + Rubella (MMR II)~1~0.00~In Patient
Other Medications:
Current Illness:
Preexisting Conditions: Condition caused by prior vaccine (seizures and developmentally delayed).
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizures and developmentally delayed with 1st set of vaccines. Had a high temperature and death with 2nd set.


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