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This is VAERS ID 250504

Case Details

VAERS ID: 250504 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Male  
Location: Virginia  
Vaccinated:2005-10-25
Onset:2005-10-30
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2006-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U1762AA / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0935P / UNK LL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0195P / UNK RL / -

Administered by: Private       Purchased by: Other
Symptoms: Irritability, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2005-10-30
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child reportedly fussy, irritable and with mild fever during interval between vaccines and death. 2/27/06 Received autopsy report which reveals patient''s COD was Sudden Unexpected Death in Childhood/ss No new information found in medical records from PCP.


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