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Life Threatening? No
Write-up: Information has been received from a health professional concerning a 16 month old male who in 11/01 was vaccinated in the left arm with a 1st dose of MMRII. Five days, post vax, the child experienced a fever and breathing disorder. Then, within the following night, his respiratory disorder was aggravated and in the morning he presented with cyanosis, respiratory distress and neurological trouble (shifty eyes). He was hospitalized, received oxygen and was ventilated. A few days later, he died. The dx was acute respiratory distress syndrome probably of viral origin. The exact cause of death was not specified. It was noted that he had received previous immunizations without any problem. No autopsy was performed. No further information is available. Follow-up info from the hospital medical record indicated that the boy was the third child of a three children family in good general state of health and was born at 36.5 weeks of amenorrhea. He experienced varicella in July 2001. He received his MMR on 10/15/2001. The infant did not present with any pathology and had an excellent psychomotor development. The first symptoms appeared on 10/20/2001 with febrile syndrome and respiratory troubles associated with a laryngitis treated with homeopathy. On 10/21/2001, two episodes of post food vomiting occurred and the child was cyanotic and dyspneic when he woke up. The prarents described their child as absent and with an altered behavior. There was no notion of head injury or drug poisoning. He received prednisone and epinephrine and was transferred to an intensive care unit. Upon admission, hemodynamic was correct, saturometry (83%) at ambient temperature. He received oxygen by nasal route and saturation reached 92-93%, fever was at 40 deg. C, tachycardia at 180/min. There was also dyspnea., absence of ocular following intermittent strabismus, obnibulation and peripheral hypertonia. The ENT examination was normal. Thorax radiography revealed a bilateral fleecy pneumopathy. Arterial garometry showed hypoxemia reacting to oxygen without any hypercapnia. The first diagnosis was the following: infectious pneumopathy associated with an infectious or hypoxic encephalopathy. During hospitalization, pulmonary lesions aggravated with stubborn hypoxemia and signs of typical and severe acute respiratory distress syndrome which necessitated intubation, ventilation controlled with enalgesic sedation and curarisation. Pneumothorax right then left were drained by pleurocath. A diffuse, generalized ventilated received antibiotics and received dobutamine after placement of a central venous route and azots monoxide. The child was transferred to another intensive care unit on the fifth day of care for severe SDRA (azote monoxide dependent) and a therapy with oscillator and respiratory assistance were introduced. On 10/27/2001 the child died. In conclusion, the child experienced an acute respiratory distress syndrome, probably secondary to an infectious pulmonary pathology, from probable viral origin. It was not possible to distinguish a hypoxic encephalopathy secondary to the SDRA and a viral infectious encephalitis. Serum and CSF were still available. No further info is available.
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