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This is VAERS ID 178593

(NOTE: This result is from the 12/8/2009 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) / MERCK & CO. INC. 0815L / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1091L / 0 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
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: WAES01112782

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 therapy 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 it was an assumed suicide. The physician reported that she only saw the client for immunizations. Unspecified medical attention was sought. Additional information has been requested. Follow-up info from the reporter indicated that "in her mind there is no connection between the vaccination and the death." Additional info has been requested.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=178593


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