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This is VAERS ID 189358

Case Details

VAERS ID: 189358 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Nevada  
Vaccinated:2002-04-16
Onset:2002-04-26
   Days after vaccination:10
Submitted: 2002-08-23
   Days after onset:119
Entered: 2002-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0905L / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1291L / 1 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaemia, Convulsion, Encephalitis, Hepatomegaly, Hypertension, Thrombocythaemia, Viral infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2002-10-25
   Days after onset: 182
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LUMBAR PUNCTURE, MRI
CDC Split Type:

Write-up: ENCEPHALITIS STATUS EPILEPTICUI 60 Day follow up states seizures, death. On October 25,2002, pt died as a result of complications of his seizures Discharge Summary received on 9/23/2002 states viral infection, Hepatomegaly, anemia, and thrombocytosis.


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