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This is VAERS ID 178593

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

Case Details

VAERS ID: 178593 (history)  
Form: Version .0  
Age: 25.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2001-11-02
Onset:2001-11-19
   Days after vaccination:17
Submitted: 2002-03-11
   Days after onset:112
Entered: 2001-12-05
   Days after submission:96
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MSD 0815L / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 1091L / 0 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: REACT UNEVAL
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2001-11-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Varicella
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Information has been received from a physician concerning a 25 year old male with no known allergies or psychiatric history and a history of varicella who on 02-NOV-2001, at 11:00 AM, was vaccinated with a dose of MMR (second generation). Concomitant ther"apy included Recombivax HB. There was no other concomitant medication. It was noted that the pt was seen later that day in the early evening, at 6:00 PM, then disappeared. On 19-NOV-2001 the pt''s dead body was recovered in the river. It was reported that


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