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This is VAERS ID 436253

Case Details

VAERS ID: 436253 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Maryland  
Vaccinated:2011-08-26
Onset:2011-08-26
   Days after vaccination:0
Submitted: 2011-09-29
   Days after onset:34
Entered: 2011-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3944AA / 5 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH476AC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1083 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1644Z / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1046AA / 2 LL / IM

Administered by: Public       Purchased by: Other
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-08-26
   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:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was found dead in bathroom after no obvious reaction.


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