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This is VAERS ID 39041

Case Details

VAERS ID: 39041 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1992-01-04
Onset:1992-01-05
   Days after vaccination:1
Submitted: 1992-01-13
   Days after onset:8
Entered: 1992-01-27
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M650HD / 4 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1158T / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-01-05
   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: NONE
Current Illness: NONE
Preexisting Conditions: Hemangioma
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 920007001

Write-up: Pt recvd MMR/HIBTITTER on 4JAN92 & had fever of 101 R x 24 hrs later; died 5JAN92;


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