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This is VAERS ID 37837

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 37837 (history)  
Form: Version .0  
Age: 1.3  
Sex: Male  
Location: California  
Vaccinated:1991-07-12
Onset:1991-07-30
   Days after vaccination:18
Submitted: 1991-12-05
   Days after onset:128
Entered: 1991-12-09
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0862T / 0 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: AUG90 @ 6mos w/DTP #3 pt exp rxn;
Other Medications: APAP, Phenobarb
Current Illness: NONE
Preexisting Conditions: seizure disorder
Allergies:
Diagnostic Lab Data: Autospy signed out as SIDS;
CDC Split Type:

Write-up: Pt has onset of sz disorder w/fever AUG90 p/3rd DTP/OPV/HBOC; recurrent afebrile sz; on 12JUL91 had MMR died of respiratory/cardiac arrest 30JUL cause undetermined;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=37837


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