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This is VAERS ID 266205

Case Details

VAERS ID: 266205 (history)  
Form: Version 1.0  
Age: 1.09  
Sex: Male  
Location: Texas  
Vaccinated:2006-11-02
Onset:2006-11-02
   Days after vaccination:0
Submitted: 2006-11-07
   Days after onset:5
Entered: 2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2006-11-03
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC Split Type:

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


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