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This is VAERS ID 39360

Case Details

VAERS ID: 39360 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Unknown  
Location: Foreign  
Vaccinated:1990-01-31
Onset:1990-01-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: No relevant hx
Allergies:
Diagnostic Lab Data: Autopsy performed-results not yet available;
CDC Split Type: WAES90021194

Write-up: Pt recvd MMR/DT/Polio vax 31JAN90 @ 10AM; @ noon pt ate lunch & was sent to bed; @ 3PM pt was found dead; autopsy was performed; MD felt uncertain regarding the causality of vax;


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