| VAERS ID: |
184346 (history) |
| Form: |
Version 1.0 |
| Age: |
1.08 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2002-04-04 |
| Onset: | 2002-04-27 |
| Days after vaccination: | 23 |
| Submitted: |
2002-05-01 |
| Days after onset: | 4 |
| Entered: |
2002-05-09 |
| Days after submission: | 8 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
1379L / 1 |
RL / SC |
| VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0573L / 1 |
LL / SC |
Administered by: Private Purchased by: Private
Symptoms: Cardiac arrest,
Infection,
Multi-organ failure,
Respiratory arrest,
Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2002-07-16
Days after onset: 80
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 44 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: RSV Bronchiolitis and pneumonia
Preexisting Conditions: Congenital ichthyosis, failure to thrive,
Allergies:
Diagnostic Lab Data: VZV-DFA (+)
CDC Split Type:
Write-up: Disseminated VZV with multi-organ failure, shock, CV arrest. Diagnosed with Superficial cellulitis, Otitis externa, hepatomegaly. 3/16/05 Autopsy report received which revealed COD to be respiratory arrest and congenital ichthyosis w/Netherton''s syndrome. Patient arrested in pediatrician''s office & unable to be revived/ss |
