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This is VAERS ID 429528

Case Details

VAERS ID: 429528 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Female  
Location: Georgia  
Vaccinated:2011-07-27
Onset:2011-08-06
   Days after vaccination:10
Submitted: 2011-08-11
   Days after onset:5
Entered: 2011-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1705Z / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Acidosis, Autopsy, Blood gases abnormal, Death, Laboratory test, Pyrexia, Respiratory arrest, Resuscitation
SMQs:, Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-08-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Ex-27wk preemie. RSV requiring hospitalization - 11/10.
Allergies:
Diagnostic Lab Data: ABG at ER showed acidosis. No other testing done at ER due to rapidity of clinical decline. Autopsy inconclusive. Further testing of tissue samples being done by state lab. Results pending.
CDC Split Type:

Write-up: Onset of fever on 8-6-11 up to 102 degrees. Playful when afebrile. Seen in doctor''s office on 8/8. Presented later to ER where resp. arrest occurred during evaluation. CPR and defibrillation with aggressive IV inotropes unsuccessful. (intermittent fever present 8/6-8/8).


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