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This is VAERS ID 101298

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 101298 (history)  
Form: Version 1.0  
Age: 7.0  
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: 1997-08-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0434B / 1 - / SC

Administered by: Other       Purchased by: Other
Symptoms: Asthma, Coagulopathy, Encephalitis, Haemorrhage, Hepatic failure, Infection, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Noninfectious encephalitis (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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? No
Previous Vaccinations:
Other Medications: Prednisone, ATB
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: polymerase chain rxn- wild type virus
CDC Split Type: WAES97062181

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,


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