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This is VAERS ID 239690

Case Details

VAERS ID: 239690 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2005-06-03
Onset:2005-06-09
   Days after vaccination:6
Submitted: 2005-06-10
   Days after onset:1
Entered: 2005-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0346P / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0989 / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cyanosis, Pulse absent
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2005-06-09
   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: 1)cetirizine 2.5 mg po q 24 hrs 2)fluticasone 44mcg oral inhalation aerosol, 2-3 puffs via Aerochamber mask q 12 hrs 3)ipratropium via nebulizer q 6 hrs or less frequently
Current Illness: No acute illness. Reactive airway disease under good control. Mild anemia diagnosed 6/3/2005.
Preexisting Conditions: Reactive airway disease, under good control at time of immunization. Recent PET placement for recurrent otitis. cow''s milk allergy; no anaphyllaxis.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the morning of 6/9/2005, patient was found in his crib apneic and without pulse. Resuscitation attempts were unsuccessful and the child was pronounced dead in the Emergency Room. Additional co start from Discharge summary rec''d 06/13/2005 -- cyanosis.


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