National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 101298

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 101298 (history)  
Form: Version .0  
Age: 7.9  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-09-13
Onset:1995-09-21
   Days after vaccination:8
Submitted: 1997-08-01
   Days after onset:680
Entered: 1997-08-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: UNK. DT ADSORBED, PEDIATRIC / UNCLASSIFIED - / - - / -
MMR: MMR II / MSD - / - - / -
OPV: ORIMUNE / LEDERLE - / - - / -
VARCEL: VARIVAX / MSD 0434B / 0 - / SC

Administered by: Other       Purchased by: Unknown
Symptoms: ASTHMA, COAGUL DIS, EDEMA LUNG, ENCEPHALITIS, HEM
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-06-01
   Days after onset: 619
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC Split Type:

Write-up: 15sep95 pt recv vax; same day pt devel hives, on 01may97 pt was admitted to hosp w/ severe asthma. pt exp respiratory compromise & was incubated & ventilated. pt was thought to have a bacterial superinfection. pt also exp pneumonia,


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=101298


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166