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This is VAERS ID 95865

Case Details

VAERS ID: 95865 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Male  
Location: New York  
Vaccinated:1991-08-30
Onset:1992-12-15
   Days after vaccination:473
Submitted: 1997-03-12
   Days after onset:1548
Entered: 1997-03-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1150T / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Thrombocytopenic purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-30
   Days after onset: 895
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: pt mom & w siblings tested positive for Von Willebrand''s disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES97030028

Write-up: pt recv vax & devel ITP & was hosp;MAY95 pt devel ITP for a 2nd time & died;


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