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This is VAERS ID 96864

Case Details

VAERS ID: 96864 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Female  
Location: Arizona  
Vaccinated:1997-03-21
Onset:1997-03-28
   Days after vaccination:7
Submitted: 1997-03-31
   Days after onset:3
Entered: 1997-04-11
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Infection, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: blood taken in ER for genetic work-up & cult r/o RSV;
CDC Split Type: AZ9710

Write-up: pt had resp ill-like sx 27MAR97;unable to appt w/med provider until 28MAR97;infant found in crib by mom AM on 28MAR97 w/no response-amb called-taken to ER;


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