| VAERS ID: |
126855 (history) |
| Form: |
Version 1.0 |
| Age: |
1.2 |
| Sex: |
Female |
| Location: |
Mississippi |
| Vaccinated: | 0000-00-00 |
| Onset: | 0000-00-00 |
| Submitted: |
1999-07-29 |
| Entered: |
1999-08-02 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / UNK |
- / - |
| VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
- / UNK |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Apnoea,
Cardiac arrest,
Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: no relevant data~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES99071550
Write-up: rpt from anonymous person concerning pt who was vax & exp slight fever, tx w/tylenol; pt found dead next morning; COD unk; the rpt stated info was recv as "hearsay'''' through small town grapevine & cannot be verified. |
