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This is VAERS ID 181884

Case Details

VAERS ID: 181884 (history)  
Form: Version 1.0  
Age: 9.0  
Sex: Female  
Location: New York  
Vaccinated:2002-01-25
Onset:2002-01-28
   Days after vaccination:3
Submitted: 2002-02-25
   Days after onset:28
Entered: 2002-03-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 5292A2 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0736L / 1 RA / SC

Administered by: Private       Purchased by: Other
Symptoms: Dyspnoea, Heart rate increased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-02-08
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Extensive antibiotics; prednisone
Current Illness: Advanced Cystic Fibrosis
Preexisting Conditions: Cystic Fibrosis; diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shots were given on 1/25/02. On 1/28/02, the pt had a temperature of 104F, extreme shortness of breath (requiring 10 liters of oxygen) to help alleviate. Also, had a heart rate of 180 +.


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