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This is VAERS ID 75498

Case Details

VAERS ID: 75498 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: New York  
Vaccinated:1995-02-10
Onset:1995-02-21
   Days after vaccination:11
Submitted: 1995-06-26
   Days after onset:124
Entered: 1995-06-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0968A / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Anaemia, Bone marrow depression, Encephalitis, Leukopenia, Mouth ulceration, Pyrexia, Thrombocytopenia, Visual disturbance
SMQs:, Severe cutaneous adverse reactions (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations: ~ ()~~~In patient
Other Medications: PPD from lederle given 10FEB95
Current Illness: Roseola?
Preexisting Conditions: innocent heart neg; dubonitz synd, SGA/IUGR;
Allergies:
Diagnostic Lab Data: CBC: WBC =.8; Het=25; Plt=22k; PT 13; PTT 37;
CDC Split Type:

Write-up: pt recv vax; T 105.4; encephalitis, bone marrow suppression, visual disturbance, mouth sores;


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