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This is VAERS ID 129511

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

Case Details

VAERS ID: 129511 (history)  
Form: Version .0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1999-07-08
Onset:1999-09-14
   Days after vaccination:68
Submitted: 1999-10-14
   Days after onset:30
Entered: 1999-10-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 0942540 / 3 - / -
HBHEPB: COMVAX / MSD 119H / 2 - / -
IPV: POLIOVAX / CONNAUGHT LTD N0700 / 2 - / -
MMR: MMR II / MSD 1184H / 0 - / -
VARCEL: VARIVAX / MSD 1671H / 0 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: AGITATION, ANOREXIA, ASTHENIA, CARDIOVASC DIS, COUGH INC
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-14
   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: NONE
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC Split Type: hypospadins, chordee

Write-up: p/vax pt devel T103.3, irritable & cranky, fever, not eating;cough, tired, lethargic, not self, not playful, fussy, no sleep, rapid heart beats, lt side of chest larger, nose flaring, trouble breathing;to ER found heart disease;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=129511


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