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This is VAERS ID 259715

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 259715 (history)  
Form: Version 1.0  
Age: 0.84  
Sex: Female  
Location: Missouri  
Vaccinated:2006-05-12
Onset:2006-05-18
   Days after vaccination:6
Submitted: 2006-07-18
   Days after onset:61
Entered: 2006-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1163R / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0381R / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1110R / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Febrile convulsion, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-05-18
   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: unknown
Current Illness: postmortem=pneumonia
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: unknown time vaccine administered is also unknown but filled in a time so could complete form.
CDC Split Type:

Write-up: Infant febrile morning of 5/18/2006 around 5:30 a.m. No other S/S per parent. Parent administered tylenol. Midday infant began seizing, mom called 911, infant transported and later pronounced dead at hospital. 7/19/06 Received death certificate which stated COD as pulmonary edema due to protracted febrile seizure. 7/28/06 Received tag-2 report from PCP. Family had moved to another state. Records accompanying report included vax records, Death Summary from ER & Autopsy Report. COD stated as non-cardiogenic pulmonary edema as the result of febrile seizures/ss


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=259715


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