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This is VAERS ID 129511

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 129511 (history)  
Form: Version 1.0  
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: 1999-10-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0942540 / 4 - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 119H / 3 - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0700 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1184H / 1 - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1671H / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Anorexia, Asthenia, Cardiovascular disorder, Cough, Dyspnoea, Insomnia, Personality disorder, Pyrexia, Somnolence, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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~ ()~~~In patient
Other Medications: NONE
Current Illness: fever, sleepy
Preexisting Conditions: hypospadins, chordee
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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=20180214&IDNUMBER=129511


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