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This is VAERS ID 124936

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

Case Details

VAERS ID: 124936 (history)  
Form: Version .0  
Age: 1.0  
Sex: Female  
Location: Georgia  
Vaccinated:1999-05-24
Onset:1999-06-01
   Days after vaccination:8
Submitted: 1999-06-15
   Days after onset:14
Entered: 1999-06-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357H / 0 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0798D / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Brain oedema, Cardiac arrest, Coagulopathy, Febrile convulsion, Gastroenteritis, Gastrointestinal haemorrhage, Grand mal convulsion, Lung disorder, Pulmonary oedema, Vaginal haemorrhage, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (broad), Ischaemic colitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-06-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99060681

Write-up: 6/1/99, 1:30pm laid down for nap as usual; woke up at 4:05 w/ fever & seizures; called EMS; to hosp by ambulance still having seizures; died at 6:58pm; according to papers from the health dept severe rxn from MMR will happen w/ fever, sz


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