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This is VAERS ID 120450

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

Case Details

VAERS ID: 120450 (history)  
Form: Version .0  
Age: 1.0  
Sex: Female  
Location: Alabama  
Vaccinated:1999-03-10
Onset:1999-03-13
   Days after vaccination:3
Submitted: 1999-03-18
   Days after onset:5
Entered: 1999-03-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 865A2 / 2 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 361453 / 2 RL / IM
MMR: MMR II / MSD 0734E / 0 LL / SC
OPV: ORIMUNE / LEDERLE 79413 / 2 - / PO
VARCEL: VARIVAX / MSD 10524 / 0 LA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: APNEA, BRONCHIOLITIS, FEVER, HEART ARREST, HEM VAGINAL
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: lt lung culture:Viridans Streptococcus, 2 colonies Candida, Haemophilus, beta lactamase+; rt lung culture: haemophilus, beta lactamase+; Blood culture: Staphylococcus epidermidis; 6/99 tissue block recv for analysis;
CDC Split Type:

Write-up: pt expired 3 days p/vax;pt arrived in ER in full arrest where pt died pt had been sick w/fever & vomiting during night;autopsy dx viral myocarditis w/ superimposed bacterial pneumonia, per examiner myocarditis probably dated prior to vax


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=120450


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