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This is VAERS ID 198985

Case Details

VAERS ID: 198985 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2002-01-04
Onset:2002-01-07
   Days after vaccination:3
Submitted: 2003-03-06
   Days after onset:423
Entered: 2003-03-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC Split Type:

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


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