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This is VAERS ID 261871

Case Details

VAERS ID: 261871 (history)  
Form: Version 1.0  
Age: 43.0  
Sex: Female  
Location: Maryland  
Vaccinated:2006-08-18
Onset:2006-08-18
   Days after vaccination:0
Submitted: 2006-08-21
   Days after onset:3
Entered: 2006-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB288AA / 2 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0215F / UNK LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Convulsion
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-08-18
   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: NONE KNOWN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received MMR vaccine and Hepatitis B vaccine at 1:45 PM. Brought in to ER at 10:48 PM in full cardiac arrest. Apparently had witnessed seizure prior to arrest.


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