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This is VAERS ID 190452

Case Details

VAERS ID: 190452 (history)  
Form: Version 1.0  
Sex: Male  
Location: Unknown  
Submitted: 2002-09-17
Entered: 2002-09-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Pyrexia, Rash morbilliform
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unk
Current Illness:
Preexisting Conditions: Immunodeficiency NOS
Diagnostic Lab Data:
CDC Split Type: WAES0209USA00733

Write-up: Information has been received from a physician concerning a male (age not given), who was vaccinated on an unknown date with a dose of MMR vaccine live (second generation) (lot # not given). At the time of vaccination the patient had an unknown immune deficiency. Following vaccination, the patient developed a morbilliform rash and fever, got better, then developed another morbilliform rash and fever for 3-4 days, the a serious illness. The patient had been diagnosed on an unknown date with hematophagocytic syndrome, and Epstein Barr virus was found. The patient had also been hospitalized on an unknown date. The patient died (cause unknown) on an unknown date. It was noted that this case took place some years ago, and had to do with a child. Morbilliform rash, fever, serious illness, hematophagocytic syndrome, Epstein Barr virus and the unknown cause of death were considered to be immediately life-threatening. Additional information has been requested.

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