| VAERS ID: |
184466 (history) |
| Form: |
Version 1.0 |
| 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) / SANOFI PASTEUR |
UA610AA / 4 |
LL / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0160L / 1 |
LL / SC |
| PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
484209 / 2 |
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 central nervous system vascular conditions (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
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. |
