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This is VAERS ID 183160

Case Details

VAERS ID: 183160 (history)  
Form: Version 1.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2002-03-21
Onset:2002-03-22
   Days after vaccination:1
Submitted: 2002-03-30
   Days after onset:8
Entered: 2002-04-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13844 / UNK - / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U0519AA / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2002-05-01
   Days after onset: 39
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 17:00 on 3/21/02, she received MMR and Tetanus vaccination. About 12 hours later (05:00 on 3/22/02), she died and was brought back. 05/01/2002 patient expired after being transferred to hospital in Budapest. Records from San Clemente Hospital: Diagnosed with severe anoxic brain injury, probably alpha coma, seizure disorder, staphylococcus aureus bronchitis, ventricular fibrillation arrest, tachycardia, elevated liver enzymes.


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