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This is VAERS ID 76787

Case Details

VAERS ID: 76787 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Unknown  
Location: Foreign  
Vaccinated:1995-05-10
Onset:1995-06-29
   Days after vaccination:50
Submitted: 1995-08-18
   Days after onset:50
Entered: 1995-08-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis, Infection, Meningism, Meningitis, Neoplasm, Strabismus, Vomiting
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (narrow), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES95080780

Write-up: pt recv vax;on 29jun95 pt exp v;10 days later,pt devel strabismus & meningism;pt was hosp on 8jul95 & subsequently died;COD not provided;30JAN96-f/u indicates Coxsackie-B viral infect caused pt''s encephalitis,dx w/ medullablastoma of men


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