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This is VAERS ID 107852

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

Case Details

VAERS ID: 107852 (history)  
Form: Version 1.0  
Age: 1.7  
Sex: Female  
Location: Pennsylvania  
   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

Administered by: Other       Purchased by: Other
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), Pulmonary hypertension (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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
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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