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This is VAERS ID 64763

Case Details

VAERS ID: 64763 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:1994-06-09
Onset:1994-06-13
   Days after vaccination:4
Submitted: 1994-07-13
   Days after onset:30
Entered: 1994-07-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1740W / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Coagulopathy, Fibrin increased, Haematuria, Leukocytosis, Nuchal rigidity, Respiratory disorder, Thrombocytopenia
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-06-20
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: coumadin;
Current Illness:
Preexisting Conditions: autoimmune disorder (anti-phospholipid antibody syndrome), allergy ASA, obesity; medical hx: recurrent thrombosis; VDRL positive;
Allergies:
Diagnostic Lab Data: mild leukocytosis & negative cxs;
CDC Split Type: WAES94061179

Write-up: approx 2 weeks p/2nd dose of MMR, pt was hospitalized due to febrile illness, abdominal pain, & thrombocytopenia; warfarin sodium crystalline was discontinued; pt developed DIC & adult respiratory distress syndrome; died from DIC & ARDS;


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