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This is VAERS ID 107852

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 107852 (history)  
Form: Version .0  
Age: 1.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1997-02-19
Onset:1997-03-01
   Days after vaccination:10
Submitted: 1998-02-23
   Days after onset:359
Entered: 1998-02-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 0 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arrhythmia, Brain oedema, Cardiac arrest, Hepatic function abnormal, Hypoxia, Infection, Myocardial fibrosis, Myocarditis
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-01
   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: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES98012678

Write-up: pt recv vax 24FEB97 & 1MAR97 pt died of a cardiac death;f/u was recv from MD:the autopsy showed myocardial fibrosis, so MD concluded the pt must have had a viral myocarditis;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=107852


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