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This is VAERS ID 99047

Case Details

VAERS ID: 99047 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Minnesota  
Vaccinated:1997-06-02
Onset:1997-06-09
   Days after vaccination:7
Submitted: 1997-06-10
   Days after onset:1
Entered: 1997-06-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0239E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0754H / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiovascular disorder, Chills, Congenital anomaly, Cyanosis, Pulmonary oedema, Pyrexia, Rash
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-06-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: pt seen for well check 2JUN97;nl H & P;given vax & 9JUN97 devel fever & rash was treated symptomatically;pt was put down 8PM & checked 9PM; then @ 10PM was noted to be cold & blue;taken to ER unable to resusitate;


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