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This is VAERS ID 239904

Case Details

VAERS ID: 239904 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Ohio  
Vaccinated:2005-05-20
Onset:2005-05-28
   Days after vaccination:8
Submitted: 2005-06-13
   Days after onset:16
Entered: 2005-06-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0608P / UNK - / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0652P / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Cardio-respiratory arrest, Cardiomyopathy, Pneumonia, Premature baby, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2005-05-29
   Days after onset: 1
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Albnuterol, Flovent, Zantac, Laser, KCL, O2
Current Illness: Trach feeding tube, BDP
Preexisting Conditions: Immune system disorder; prematurity; hospitalization
Allergies:
Diagnostic Lab Data: Body temp high temperatures
CDC Split Type: WAES0506USA00683

Write-up: Information has been received from a RN concerning a 21 month old immunocompromised male who was vaccinated with a dose of varicella virus vaccine live. Concomitant vaccination included a dose of measles virus vaccine live (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). Subsequently the pt was hospitalized and died two weeks later (not further specified). A product quality complaint was not involved. Additional information was received from the RN who reported that the pt had a lot of problems. The pt was hospitalized until he was 20 months old with a diagnosis of extreme prematurity among other problems. The nurse did not know the cause of death but did indicate that high temperatures were involved. Additional information was received from a health professional at a pediatricians office who reported that the pt''s demise had nothing to do with the vaccinations. The pt''s experience was considered to be immediately life threatening and disabling by the RN. Additional information has been requested. Received Autopsy Report which revealed COD as acute bronchopneumonia, bronchopulmonary dysplasia, dilated cardiomyopathy & prematurity.


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