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This is VAERS ID 92503

Case Details

VAERS ID: 92503 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1996-11-05
Onset:1996-11-13
   Days after vaccination:8
Submitted: 1996-11-27
   Days after onset:14
Entered: 1996-12-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Coronary artery disease
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-11-13
   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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96111526

Write-up: pt recv vax 5NOV96 & 13NOV96 pt died;pt had been an otherwise healthy individual;COD unk;MD did not think death was d/t vax;gross post-mortem revealed no anomalies;MD awaiting microscopy & toxicology reports;


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