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From the 6/11/2021 release of VAERS data:

Found 385 cases where Vaccine is MMR and Patient Died and Vaccination Date on/before '2015-01-31'



Case Details

This is page 13 out of 39

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VAERS ID: 198985 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Female  
Location: California  
Vaccinated:2002-01-04
Onset:2002-01-07
   Days after vaccination:3
Submitted: 2003-03-06
   Days after onset:423
Entered: 2003-03-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 05206A2 / UNK LA / IM
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 706A2 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 07422 / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Cardiac arrest, Headache, Myocarditis, Nausea, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: 12/12/01 diagnosed scabies cleared on 1/4/02 T 100 oral
Allergies:
Diagnostic Lab Data: Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen
CDC Split Type:

Write-up: Pt initially seen for physical exam on 12/12/01. The physical was wnl except for dental caries, a referral was made to dentist, and a diagnosis of Scabies. The family was given scabies education. A Hct/Hgb, with 99.5 NAAC, urine/UC, vision screen, hearing screen and PPD (all negative results) MMR, HBV and HAV given on 1/4/02.


VAERS ID: 201354 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:1999-01-19
Onset:0000-00-00
Submitted: 2003-04-08
Entered: 2003-04-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2710A2 / 1 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0786H / 2 RL / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C00934600 / 1 LL / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Drooling, Fatigue, Staring, Urinary incontinence
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-10-03
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client received hep B #1 on 1/19/99, #2 on 4/7/99, #3 on 8/10/99. Parents stated that child started acting strange 24 hrs after first Hp B vaccine. She started staring into space, complained of being tired and grades dropped over period of time. She had the first seizure on 8/6/99 at a friend''s house and fell off the chair. After the second Hp B vaccine, she started drooling and wet the bed twice over a period of time. After the third vaccination, seizures became progressively worse. Child was under the care of the neurologist and medical services. On 10/13/01 child died in her sleep as a result of a "brain seizure."


VAERS ID: 202332 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2003-02-01
Onset:2003-02-06
   Days after vaccination:5
Submitted: 2003-04-28
   Days after onset:80
Entered: 2003-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / 2 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
SMALL: SMALLPOX (DRYVAX) / PFIZER/WYETH 4020071 / 1 - / -
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR - / UNK - / -

Administered by: Military       Purchased by: Military
Symptoms: Coma, Hypertrophy
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-02-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: See tox screening in box 7.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See box 7.
CDC Split Type:

Write-up: Active-duty soldier, 181 cm tall, 180 lbs, found unresponsive in barracks 5-6 days post smallpox vaccination. Post-mortem toxicology positive for methadones (0.26 mg/L), diazepam (0.33 mg/L), nordiazepam (0.22 mg/L), but not temazepam, alprazolam, or dextromethorphan. Autopsy revealed concentric L ventricular hypertrophy, but no myocarditis. Conclusion: Vaccination unrelated to soldier''s death.


VAERS ID: 206895 (history)  
Form: Version 1.0  
Age: 1.29  
Sex: Female  
Location: California  
Vaccinated:2003-03-17
Onset:2003-05-22
   Days after vaccination:66
Submitted: 2003-07-23
   Days after onset:62
Entered: 2003-08-01
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Acidosis, Hepatic necrosis, Hepatitis, Renal failure, Respiratory failure, Sepsis, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatitis, non-infectious (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2003-05-31
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200301423

Write-up: This subject is a one year old female, who was admitted to the hospital due to systemic inflammatory response syndrome while enrolled in a Phase IV Daptacel study. The subject received one dose of Daptacel vaccine: along with other pediatric vaccines on 3/17/03. The subject developed symptoms 65 days post immunization and was admitted to the hospital three days later 5/25/03. The subject was transferred from hospital to another hospital on 5/26/03 with the diagnosis of acute respiratory failure, presumed streptococcal sepsis and hepatitis. While at hospital, the pt expired on 5/31/03 with a diagnosis of SIRS, acidosis and acute liver necrosis. The event of systemic inflammatory response syndrome was reported by the investigator as unrelated to the study vaccine. No autopsy was performed. Follow up on 04/21/04: "New version created to place Infanrix into pt''s history screen." Medical Records received on 8/05/2003 states kidney failure and thrombocytopenia.


VAERS ID: 207834 (history)  
Form: Version 1.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2002-11-14
Onset:0000-00-00
Submitted: 2003-08-11
Entered: 2003-08-14
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / UNK - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UB245AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Military       Purchased by: Unknown
Symptoms: Bacterial infection, Cough, Drug ineffective, Dyspnoea, Laboratory test abnormal, Pharyngitis, Rash maculo-papular, Respiratory distress, Sepsis, Shock
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Lack of efficacy/effect (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-12-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Diagnostic Laboratory: PCR was positive for Neisseria Meningococcal infection serogroup C.
CDC Split Type: 200301574

Write-up: From initial information received on 8/7/03 from a medical professional, regarding an adverse event occurring in the US, it was reported that an 18year old male patient received MENOMUNE, lot number UB245AA, FLUZONE (lot number not reported), TUBERSOL (lot number not reported), HEPATITIS A VACCINE (lot number and manufacturer not reported, HEPATITIS B VACCINE (lot number and manufacturer not reported), MMR (lot number not reported), and PNEUMOVAX (lot number not reported) administered on 11/14/02. All vaccines were administered on the same date. The patient died on 12/15/02. The CDC investigation confirmed that the patient was positive for serogroup C, Meningococcal infection. The onset date of signs and symptoms were not reported. An autopsy was performed, however, results were not available at the time of this report. Follow-up information: Information has been received from a health professional concerning an 18 year old male patient who was healthy with no adverse entry who on 11/14/2002 was vaccinated with a dose of MMRII (Lot # not reported). Concomitant therapy on 11/14/2002 included a dose of hepatitis A vaccine (inactive) (manufacturer unknown) (Lot # not reported), a dose of hepatitis B virus vaccine rHBsAg (yeast) (manufacturer unknown) (Lot # not reported), a dose of pneumococcal vaccine 23 polyvalent (MSD) (Lot # not reported), a dose of tuberculin in purified protein derivative (TUBERSOL) (Lot # not reported), a dose of influenza virus vaccine (FLUZONE) (Lot # not reported) and a dose of meningococcal polysaccharide vaccine (MENOMUME-A/C/Y/W-135) (Lot # UB245AA). Subsequently the patient died on 12/15/2002. It was confirmed that the patient was positive for serogroup C Meningococcal infection. The onset date of signs and symptoms were not reported. An autopsy was performed; however, the results were not available at the time of the report. From additional information received on 08/12/2003 from a pathology department, it was reported that the patient presented with an acute onset of a rash on his feet that spread to his face over a period of a few hours, after a 3 day history of a cough and sore throat. The symptoms progressed rapidly to severe respiratory distress and shock. The patient was treated with advanced cardiac life support in the ICU (intensive care unit) and died within three hours of presenting to the hospital. The patient died at 1:01 pm on 12/15/2002; the autopsy was done the following day and showed that the cause of death was Neisseria Meningitidis Septicemia (Meningococcemia). Gross autopsy findings included evidence acute shock syndrome with diffuse petechia and hemorrhage to multiple organs, visceral congestions, shock kidneys, and a blothcy erythematous rash to the organs and a few scattered foci of acute inflammation within the myocardium and meninges. The clinical presentation, autopsy findings, and laboratory PCR results were consistent with Neisseria Meningitidis (meningococcal) Septicemia (special pathogens branch # M10158). The manner of death was natural. The CDC confirmed that the patient was positive for serogroup C Meningococcal infection. Final anatomical diagnosis from the autopsy report included: Diffuse discrete petechiae and small hemorrhages involving multiple organs, serosa and mucosal surfaces (intestines, mesentery, epicardium, myocardium, renal cortex, adrenals, lungs, pharynx, bronchi, skeletal muscle and conjuctica), pulmonary edema and visceral congestion, bilateral pleural and pericardial effusions, blotchy erythematous rash on face, trunk, arms and legs, shock kidneys with diffuse pale cortices. there was no purulent meningeal exudates present. The PCR results were positive for Neisseria Meningitidis Serogroup C. Microscopic findings included: Numerous fibrin micro thrombi in heart, lungs, liver, glomeruli, brain and oropharynx and scattered small foci of acute inflammation in meninges and myocardium associated with hemorrhage and focal myocyte necrosis. Microscopic descriptions included: Trachea-diffuse mucosal and submucosal hemorrhage without inflammation. Lung-diffuse alveolar damage with numerous scattered fibrin and conspicous granulocytes present in red pulp. Liver-sinusoidal congestion with sinusoids distended by granulocytes and scattered fibrin micro thrombi. Prostate and bladder-mucosal and glandular autolysis, no pathologic diagnosis. There were no radiographs taken. Toxicology results included: Volatiles-the blood and vitereous fluid were examined for the presence of ethanol at a cutoff of 20 mg/dl. No ethanol was detected. The following drugs were detected: Positive Lidocaine-Lidocaine was detected in the liver by gas chromatography and confirmed by gas chromatography/mass spectrometry. Positive Atropine-Atropine was detected in the liver by gas chromatography/mass.


VAERS ID: 213168 (history)  
Form: Version 1.0  
Age: 1.42  
Sex: Male  
Location: California  
Vaccinated:2003-06-30
Onset:2003-07-14
   Days after vaccination:14
Submitted: 2003-11-24
   Days after onset:133
Entered: 2003-12-01
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 530A2 / 4 - / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1236M / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0975M / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Brain neoplasm malignant, Collapse of lung, Neuroblastoma, Pleural effusion, Pneumonia, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological malignant tumours (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-09-01
   Days after onset: 49
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest x-rays: 7/28/03: at 21:48 hrs-show bilateral extensive pleural effusions and areas of pulmonary edema or pneumonia. 7/28/03 at 22:34 hrs-show bilateral pleural effusions and progressive diffuse pulmonary opacification, consistent with pulmonary edema, pulmonary hemorrhage, ARDS or severe diffuse pneumonia. Feeding tube is in the stomach. Tube is in the trachea. Broviac catheter is in the right atrium. 23:33 hrs-indicatiosn: respiratory failure. Status post drainage of bilateral pleural effusions with pigtail catheters. Continued diffuse pulmonary disease.
CDC Split Type: 200303028

Write-up: This subject is a 17 month old male, who was noted to have vomiting and an abdominal mass while enrolled in a Comparative post-marketing safety study of CPDT Vaccine Adsorbed administered with other recommended vaccines according to the standard of care, at 2, 4, and 6 months of age in infants and as a booster to toddlers, Protocol Number P3T08. The subject received four doses of Infanrix. The last dose prior to the event was given on 6/30/03. Other vaccines given on the same date were IPV, PRP-T, MMR and VZV. The subject developed vomiting and an abdominal mass was found, 14 days post-immunization. The subject underwent a tumor biopsy on 7/25/03, along with bone marrow aspirations and biopsies. The pt was diagnosed as a stage 4 Neuroblastoma and was started on the COG A3973 protocol. According to the protocol, the pt was due to have a stem cell harvest after two cycles of chemotherapy. The subject was to have a future autologous stem cell transplant if enough stem cells were harvested and other requirements of the protocol has been completed. There was unanimous agreement among the transplant committee that this subject was a candidate for a stem cell transplant assuming the subject remained on the COG protocol, and the subject met transplant criteria. The subject died on 9/1/03. The event of neuroblastoma, secondary brain/ spine cancer, anoxic brain damage, pneumonia, and pulmonary collapse was reported by the investigator as not related to the study vaccine. Autopsy is pending. A 15-day follow up report received 12/19/2003 adds no new info.


VAERS ID: 213825 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Michigan  
Vaccinated:2003-05-22
Onset:2003-06-05
   Days after vaccination:14
Submitted: 2003-12-04
   Days after onset:182
Entered: 2003-12-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Bacterial infection, Brain oedema, Bronchitis, Pneumonia
SMQs:, Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-06-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


VAERS ID: 214715 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:1998-06-02
Onset:0000-00-00
Submitted: 2004-01-02
Entered: 2004-01-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0238E / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0312USA02390

Write-up: Information has been received from an attorney concerning a pt who on 6/2/98 was vaccinated with a dose of hep B virus vaccine. Other reported vaccinations included a dose of MMR II (620003/0238E). Subsequently the pt experienced death. The cause of death was death unexplained. Additional info will be provided as it becomes available.


VAERS ID: 215919 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Missouri  
Vaccinated:2003-12-09
Onset:2003-12-11
   Days after vaccination:2
Submitted: 2004-01-29
   Days after onset:49
Entered: 2004-02-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA859AA / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0100N / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493264 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0544N / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-12-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to PCN
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: None. Had diarrhea 2 weeks before.


VAERS ID: 217129 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Male  
Location: California  
Vaccinated:2004-02-26
Onset:2004-02-26
   Days after vaccination:0
Submitted: 2004-03-02
   Days after onset:5
Entered: 2004-03-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 21893B9 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0915N / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0178N / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493505 / 2 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0196N / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Adrenal haemorrhage, Bacterial infection, Crying, Heart disease congenital, Pyrexia, Sepsis, Shock, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Congenital, familial and genetic disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2004-02-26
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 1/2 tab per day (baby Aspirin)
Current Illness: NONE
Preexisting Conditions: Cardiac heterotaxy; Dextrocardia; Complete AV Septal defect; Pulmonary Atresia
Allergies:
Diagnostic Lab Data: blood culture (+) for streptococcus pneumoniae;
CDC Split Type:

Write-up: According to family, 3 hours after immunizations given, patient had vomiting and temperature of 103. Arrived in ER 2/26/04 at 21:15; temp was 106 rectally. C/C to ER; was crying, fever, vomiting. Died 2/26/04 at 23:58. The hospital discharge summary received on 3/23/04 states meningococcaemia/ sepsis and congenital heart dx. Nurse follow up on 09/21/04 states: "septic shock, adrenal hemorrhage."


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