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This is VAERS ID 252079

Case Details

VAERS ID: 252079 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Unknown  
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted: 2006-01-12
Entered: 2006-02-28
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant
SMQs:, Non-haematological malignant tumours (narrow), Non-haematological tumours of unspecified malignancy (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


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