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This is VAERS ID 213825

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 213825 (history)  
Form: Version 1.0  
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 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491169 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0865M / 1 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

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=20180914&IDNUMBER=213825


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