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Found 469 cases where Vaccine targets Measles (MEA or MER or MM or MMR or MMRV) and Patient Died and Vaccination Date on/before '2018-11-30'

Case Details

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VAERS ID: 252076 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Unknown  
Vaccinated:2004-11-03
Onset:2004-11-28
   Days after vaccination:25
Submitted: 2006-01-12
   Days after onset:410
Entered: 2006-02-28
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1527AA / UNK UN / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE237AA / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0181N / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH A74399C / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardio-respiratory arrest, Congenital anomaly, Convulsion, Encephalopathy, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2004-11-28
   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:
Current Illness:
Preexisting Conditions: The subject''s past medical history included central hypoventilation syndrome. The subject had received a first dose of DAPTACEL, lot number not available, on 15 September 2003; a second dose of DAPTACEL, lot number C1245AA on 04 December 2003 and a third dose of DAPTACEL, lot number C1354AA, on 05 March 2004.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200500887

Write-up: Initial SAE report received on 13 May 2005. Additional information received on 06 June 2005. This subject is 16 month old male, who died from the congential anomaly static encephalopathy while enrolled in a study of DAPTACEL administered with other recommended vaccine according to the standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received four dose of study vaccine. The last dose prior to the event was given on 03 November 2004. On that same date, the subject concomitantly received a dose of ActHib, lot number UE237AA (lot number 200672); a dose MMR/Measles, Mumps and Rubella Vaccine lot number 0181N and a dose of Prevenar lot number A74399C. The subject suffered from static encephalopathy and had a past medical history of central hypoventilation syndrome. The subject died on 28/Nov/2004, 25 days post-vaccination. Autopsy information is pending. The event of static encephalopathy was reported by the investigator as not related to the study vaccine. From additional information received on 06 June 2006 it was reported that pathological studies determined that the patient had Rett Syndrome. During internal review on 17 June 2005 it was noted that congenital anomaly was ticked in error for serious criteria. A corrective version was created to amend this. List of additional information available in source documents. Death certificate received which revealed COD: cardiopulmonary failure, arrhythmia-V-tach, encephalopathy and seizure disorder/ss


VAERS ID: 252078 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Unknown  
Vaccinated:2003-11-14
Onset:2004-09-28
   Days after vaccination:319
Submitted: 2006-01-12
   Days after onset:471
Entered: 2006-02-28
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C1245AA / UNK UN / -
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UA873AA / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0131M / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 493505 / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0344N / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asphyxia, Aspiration
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200500900

Write-up: This subject is a two year old female, who expired due to asphyxiation while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and tetanus toxoids and acellular pertussis vaccine absorbed) 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. The subject received four dosed of the study vaccine. The last dose prior to the event was given on 11/14/2003. Other vaccines administered on that day included a dose of ACTHIB, lot number W1452 (manufacturer lot number UA873AA), a dose of MMR lot number 0131N, a dose of Prevenar lot number 493505, a dose of VZV lot number 0344N. The routes and sites of administration were not provided. The subject presented to the ER in full code for probable aspiration of food. The subject subsequently deteriorated and resuscitation was unsuccessful. The subject expired due to asphyxiation 319 days post immunization. The coroners office determined that the cause of death was a bean in the subjects trachea. Autopsy results were not been requested. The event of asphyxiation was reported by the investigator as unrelated to the study vaccine. Further information is not anticipated, this case is considered closed. 3/7/06 Autopsy report received which states COD as asphyxia secondary to bean lodged in mid trachea./ss


VAERS ID: 252079 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Unknown  
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted: 2006-01-12
Entered: 2006-02-28
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow)

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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


VAERS ID: 255329 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2006-03-16
Onset:2006-04-01
   Days after vaccination:16
Submitted: 2006-05-08
   Days after onset:36
Entered: 2006-05-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other       Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Sepsis (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-05-25
   Days after onset: 53
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 41 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC Split Type: WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


VAERS ID: 257684 (history)  
Form: Version 1.0  
Age: 1.33  
Sex: Female  
Location: Arkansas  
Vaccinated:2006-05-31
Onset:2006-06-01
   Days after vaccination:1
Submitted: 2006-06-02
   Days after onset:1
Entered: 2006-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U1774CA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE795AA / 3 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR YO991 / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0092F / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08653R / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1022R / 1 LL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardio-respiratory arrest, Circulatory collapse, Dehydration, Hypoxia, Neurodevelopmental disorder, Pneumonia, Pyrexia, Respiratory distress
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (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), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-06-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid, Tabs 15 mg Solutab PO Oxygen at home device Albuterol MDI, Inhaler, 90 mcg, Atrovent nasal Spray (0.03%) Metoclopramide, Syrup 5mg/5ml .8ml Nystatin Powder Was given Augmentin ES-600 susp, for otitis media the day she was in offic
Current Illness: Otitis Media Bi latteral
Preexisting Conditions: Gerd, Scoliosis- Idiopathic, Tracheomalacia,Wheezing, Developemental Delay, Speech Delay, Otitis Media-Chronic Supporative Bilateral
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received immunizations in this office on 5/31/06. She was noted to have an otitis media withoutfever. Mother called the office on 6/1/06 and talked to the nurse because she was running a fever and not acting quite right. She was given standard instruction for post immunization. During the night she became febrile and started having respiratory difficulties with her pulse ox dropping into the 80''s. Mother drove her to the emergency room. In route the child became apneic. By the time she arrived she was asytolic. Rescussitation was unsuccessful. She had a temperature of 107 when she arrived in the ER.This patient had fever and cardiovascular colapse within 48 hours of immunization. I feel this was a major immunization reaction. 7/18/06 Received medical records from ER which reveal patient developed respiratory distress & failure. PMH: tracheomalacia, developmental delay, chronic respiratory deficitis & congenital heart defects. Had trach & PEG in place & was on home O2. Developed decreased LOC prior to hospitalization with cyanosis despite O2. Found to be febrile at 107, apneic & asystolic in ER & resuscitation was unsuccessful. 7/31/06 Received medical records from PCP which did not add new info. 8/9/06 Received Death Certificate which stated COD as pneumonia with dehydration with tracheomalacia as underlying cause./ss


VAERS ID: 259715 (history)  
Form: Version 1.0  
Age: 0.84  
Sex: Female  
Location: Missouri  
Vaccinated:2006-05-12
Onset:2006-05-18
   Days after vaccination:6
Submitted: 2006-07-18
   Days after onset:61
Entered: 2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-05-18
   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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC Split Type:

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


VAERS ID: 261871 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Female  
Location: Maryland  
Vaccinated:2006-08-18
Onset:2006-08-18
   Days after vaccination:0
Submitted: 2006-08-21
   Days after onset:3
Entered: 2006-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB288AA / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0215F / UNK LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Convulsion
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-08-18
   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 KNOWN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received MMR vaccine and Hepatitis B vaccine at 1:45 PM. Brought in to ER at 10:48 PM in full cardiac arrest. Apparently had witnessed seizure prior to arrest.


VAERS ID: 264460 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2006-10-09
Entered: 2006-10-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -

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

Life Threatening? Yes
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: Unknown
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0610USA03251

Write-up: Information has been received from a certified medical assistant concerning a 4-year-old female who in approximately 2002 was vaccinated with a dose of measles virus vaccine live (+) mumps virus vaccine live (+0 rubella virus vaccine live. In approximately 2002, suddenly after the vaccine was given, the patient died. The child''s autopsy was inconclusive. No other information was available. There was no product quality complaint. The event was also considered to be immediately life-threatening by the reporter. Additional information has been requested.


VAERS ID: 266205 (history)  
Form: Version 1.0  
Age: 1.09  
Sex: Male  
Location: Texas  
Vaccinated:2006-11-02
Onset:2006-11-02
   Days after vaccination:0
Submitted: 2006-11-07
   Days after onset:5
Entered: 2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-11-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC Split Type:

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


VAERS ID: 269910 (history)  
Form: Version 1.0  
Age: 1.19  
Sex: Male  
Location: California  
Vaccinated:2006-12-01
Onset:2006-12-12
   Days after vaccination:11
Submitted: 2006-12-22
   Days after onset:10
Entered: 2007-01-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Coma
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: 2006-12-12
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


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