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This is VAERS ID 255329

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 255329
VAERS Form:
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine."Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated i


Changed on 12/8/2009

VAERS ID: 255329 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / -
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: (blank) 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': (blank) WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine."Concomitant vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated i in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumoni


Changed on 1/7/2013

VAERS ID: 255329 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumoni pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from children''s hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 6/14/2014

VAERS ID: 255329 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from children''s hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 3/14/2015

VAERS ID: 255329 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from children''s hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 2/14/2017

VAERS ID: 255329 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from children''s hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 9/14/2017

VAERS ID: 255329 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / - UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UNK UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 2/14/2018

VAERS ID: 255329 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 6/14/2018

VAERS ID: 255329 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 8/14/2018

VAERS ID: 255329 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 9/14/2018

VAERS ID: 255329 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.


Changed on 10/14/2018

VAERS ID: 255329 Before After
VAERS Form:1
Age:1.0
Sex:Female
Location:Wisconsin
Vaccinated:2006-03-16
Onset:2006-04-01
Submitted:2006-05-08
Entered:2006-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Other      Purchased by: Other
Symptoms: Candidiasis, Cerebral haemorrhage, Chromosome abnormality, Coagulopathy, Dehydration, Hypoxia, Immune system disorder, Laboratory test abnormal, Liver function test abnormal, Lung disorder, Pneumonia, Pulmonary fibrosis, Rash vesicular, Respiratory distress, Sepsis, Viral infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-05-25
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 41     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Inhaled corticosteroid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bronchial irrgation-4/9/06?-(+) for mumps on day 3; Diagnostic lab-4/9/06?-ifa negative for measles Initial WBC 5,400. EEG revealed diffuse cerebral dysfinction. Elevated LFTs & coagulopathy. Severe lymphopenia
CDC 'Split Type': WAES0604USA03984

Write-up: Information has been received from a physician concerning a 13 month old female who on 3/16/2006 was vaccinated with a dose of Varicella virus vaccine live. Concomitant vaccine administered on the same day included a doe of measles mumps rubella vaccine. Concomitant therapy included an inhaled corticosteroid unspecified. On 4/9/2006 the patient was diagnosed with adenosine deaminase deficiency and the mumps virus had been isolated from her bronchial tract. The patient was hospitalized, was being treated in the critical department, and was on a ventilator. At the time of the report the patient had not recovered. It was noted that there were numerous diagnostic studies, unspecified. Follow up information from a physician indicated that the patient was currently being treated, in April 2006, for disseminated Varicella. The patient was also being treated for lung disease attributed to Varicella, which had shown response to treatment. The patient was still being mechanically ventilated, which required 50% supplemental oxygen. A bronchioalveolar lavage sample was positive for mumps on day three. An immunofluorescence assay was negative for measles. The treatment of the patient has included acyclovir, foscarnet, ribavirin IV, amantadine, and pegylated adenosine deaminase. Current therapy included amantadine, ribavirin and acyclovir. The patients reaction was considered to be immediately life threatening, disabling, and an important medical event by the reporter (OMIC). Additional information has been requested. 6/1/06 Received t/c from reporter with unofficial COD of intracranial hemorrhage which was probably caused by the drug Ecmo. Had also used 2 IND drugs on this patient (ribavirin & VeriZIG) PMH: preexisting pulmonary fibrosis & intermittent thrush since birth. Patient had been hospitalized past fall with extensive pulmonary infection for approx 3 weeks. Patient was on less than 3% percentile mark in physicial development. 6/19/06 Received medical records from prior hospitalization 8/20/05-9/4/05 w/dx: pneumonia, hypoxia & dehydration. PMH: protracted history of colds & ear infections. Birth hx: pregnancy complicated by oligohydramnios, c-section, breech presentation, 6#, length 19 in & head circum 33.5. Blood cultures during hospitalization were neg. Final dx: viral pneumonia. 7/13/06 Received medical records from hospital for admit 4/17/06-5/25/06. Final Dx: disseminated varicalla infection, septic shock & respiratory failure requiring mechanical ventilation. Final dx: ADA deficient SCID, ARDS, septic shock, intracranial hemorrhage. 8/4/06 Received d/c summary from hospital which revealed final dx as respiratory failure.

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