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This is VAERS ID 124936

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 124936 (history)  
Form: Version 1.0  
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 / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0798D / 3 MO / 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), Haemorrhage laboratory terms (broad), 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), Generalised convulsive seizures following immunisation (narrow), Noninfectious diarrhoea (broad), Respiratory failure (narrow), Hypoglycaemia (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: twin recv OPV same day & devel diarrhea (see #125065)~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: 6/1/99 blood culture neg, CSF neg, metabolic screen for toxic substance neg, mean platelet vol 6.9 low,
CDC Split Type: WAES99060681

Write-up: pt recv vax 5/24/99 & 6/1/99 pt was found to have a fever & p/waking up from nap, had sz & was rushed to ER where was unable to be resuscitated;COD @ time of reporting was unk;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=124936


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