VAERS ID: |
184904 (history) |
Form: |
Version 1.0 |
Age: |
2.08 |
Sex: |
Male |
Location: |
Foreign |
Vaccinated: | 2001-05-16 |
Onset: | 2001-06-03 |
Days after vaccination: | 18 |
Submitted: |
2002-05-14 |
Days after onset: | 345 |
Entered: |
2002-05-21 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Alanine aminotransferase increased,
Aspartate aminotransferase increased,
Aspiration,
Blood calcium decreased,
Blood chloride decreased,
Blood creatine phosphokinase increased,
Conjunctivitis,
Cyanosis,
Pyrexia,
Sudden infant death syndrome,
Upper respiratory tract infection SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Conjunctival disorders (narrow), Ocular infections (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2001-06-04
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: Preexisting Conditions: Febrile convulsion Allergies: Diagnostic Lab Data: CRP-less than 7; leucocytes-6.2; hemoglobin-13.5; thrombocytes-153; neutrophils-1.99; lymphocytes-3.42; monocytes-0.72; cephatest-70H; creatinine-95H; urea-4.6; sodium-139; chloride-84; calcium-1.83; glucose-14.1; plasma aspartate aminotransferase test 1612; plasma alanine aminotransferase test-1132; serum alkaline phosphatase test-375; serum lactate dehydrogenase test-6567; serum creatine kinase test-5424; total protein-62; albumin-39; urine clear; Autopsy-no certain cause of death CDC Split Type: WAES0205USA00328
Write-up: Information has been received from a health authority concerning a 25 month old male with a history of 2 episodes of uncomplicated fever convulsions who on 5/16/01 was vaccinated with the 1st dose of MMRII (lot unknown). There was no concomitant medication. On 6/4/01, 19 days post vax, the pt was found lifeless in his bed at 11:55 AM on his back with blue lips and vomit in his pharynx. It was reported that he had conjunctivitis the day before, upper respiratory infection for 1 day and a fever of 38.6C, in the morning but seemed unaffected. He went to sleep about 09:30 AM and at 11:30 AM was observed to be sleeping on his stomach. No petechia or other rash was noted. The autopsy showed no certain cause of death and the cause of death was classified as borderline SIDS. It was reported that no findings point to causal relationship to the vaccine. No further information is available. |