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This is VAERS ID 26224

Case Details

VAERS ID: 26224 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Missouri  
Vaccinated:1990-07-31
Onset:1990-08-05
   Days after vaccination:5
Submitted: 1990-10-06
   Days after onset:62
Entered: 1990-10-12
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH - / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Face oedema, Hypersensitivity, Oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-08-11
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Hypoglycemic of Newborn; R/O Sepc as newborn
Allergies:
Diagnostic Lab Data: Chest X-Ray Neg; All lab work neg; SGOT = 200; NA 123; EKG neg; ECHO heart neg
CDC Split Type:

Write-up: Pt vaccinated with MMR/HIB developed puffy eyes seen in office dx allergy given Benadryl; Seen 8AUG some vomiting, 9AUG admitted more puffiness & edematous See WORM for more details.


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