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This is VAERS ID 64421

Case Details

VAERS ID: 64421 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Male  
Location: Foreign  
Vaccinated:1994-06-06
Onset:1994-06-09
   Days after vaccination:3
Submitted: 1994-06-27
   Days after onset:18
Entered: 1994-07-05
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Myocarditis, Pharyngitis, Rhinitis
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1994-06-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10JUN94: Lumbar puncture nl, blood cx nl;
CDC Split Type: WAES94067509

Write-up: 09JUN94 pt expd rhino-pharyngitis & was rx''d w/sulphamethoxazole trimethoprim & cetrizine; 10JUN94 pt died; 11JUN94 an autopsy was performed & fulminant myocarditis was found;


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