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This is VAERS ID 189882

Case Details

VAERS ID: 189882 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:1997-06-12
Onset:1997-06-12
   Days after vaccination:0
Submitted: 2002-09-03
   Days after onset:1909
Entered: 2002-09-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 444259 / 4 LL / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2371A2 / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0009E / 2 - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / PFIZER/WYETH 0760 / 3 LL / -

Administered by: Private       Purchased by: Other
Symptoms: Chromosome abnormality, Drug administration error, Lethargy
SMQs:, Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-09-25
   Days after onset: 1201
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Born with a 5mm ventrical septal defect-healed by age 20 mos.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given an "extra hep B" shot in error. He became lethargic for three days after the vaccines were administered. Pt died from Adrenoleukodystrophy. His mother was not the carrier, symptoms of ALD began three months after vaccines.


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