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This is VAERS ID 184466

(NOTE: This result is from the 3/2/2010 version of the VAERS database)

Case Details

VAERS ID: 184466 (history)  
Form: Version .0  
Age: 1.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2002-03-05
Onset:2002-03-18
   Days after vaccination:13
Submitted: 2002-05-07
   Days after onset:49
Entered: 2002-05-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UA610AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0160L / 0 LL / SC
PNC: PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 484209 / 1 RL / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Bacterial infection, Brain oedema, Cerebral haemorrhage, Hypersensitivity
SMQs:, Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic cerebrovascular conditions (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-03-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pink throat and slightly enlarged tonsils and stuffy nose per F/U 6/10/02
Preexisting Conditions: Mom reported vomiting and diarrhea that stopped 4 days prior to death; went to ER per F/U 6/10/02, also has history of allergies
Allergies:
Diagnostic Lab Data: Autopsy performed-cause of death; nodular pneumonitis with allergic component
CDC Split Type: LA020501

Write-up: The pt died suddenly at the babysitter''s; dx on death certificate is nodular pneumonitis with allergic component. Mother is concerned that child''s allergic reaction was possibly related to vaccine. Received HIB, MMR, PCV-7 on 3/5/02. Per F/U 6/10/02 also had cerebral edema and congestion, scattered colonies of bacterial-type elements within these nodular areas and intra-alveolar hemorrhage.


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