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This is VAERS ID 213825

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 213825 (history)  
Form: Version .0  
Age: 1.0  
Sex: Female  
Location: Michigan  
Vaccinated:2003-05-22
Onset:2003-06-05
   Days after vaccination:14
Submitted: 2003-12-04
   Days after onset:182
Entered: 2003-12-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1012M / 0 RL / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 491169 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 0 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Bacterial infection, Brain oedema, Bronchitis, Pneumonia
SMQs:, Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-06-05
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child died suddenly at day care on or about 6/5/03. No other specifics known. Autopsy report report received on 12/16/2003 states COD was bacterial pneumonia, bronchitis, and cerebral edema.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=213825


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