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This is VAERS ID 445693

Case Details

VAERS ID: 445693 (history)  
Form: Version 1.0  
Age: 1.01  
Sex: Male  
Location: D.C.  
Vaccinated:2011-11-28
Onset:2011-12-02
   Days after vaccination:4
Submitted: 2011-12-16
   Days after onset:14
Entered: 2011-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C39999AA / 4 RL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1068AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0513AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916921 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0950AA / 1 LL / SC

Administered by: Unknown       Purchased by: Public
Symptoms: Coagulopathy, Epistaxis, Haemoptysis, Peritoneal dialysis, Platelet count decreased, Renal failure acute, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (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), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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:
Other Medications: Pulmicort, Albuterol, Poly-vi-sol with iron, ibuprofen
Current Illness: no
Preexisting Conditions: Prematurity (born at 29 weeks gestation) Hx of thrombocytopenia and hepatitis in NICU - resolved Asthma/chronic lung disease Developmental delay
Allergies:
Diagnostic Lab Data: unknown - evaluation at Hospital
CDC Split Type:

Write-up: Patient traveled to another country on 12/1/11. Following day, began bleeding from his nose and coughing up blood. Found to have low platelets and profound coagulopathy. Subsequently has developed respiratory failure and acute renal failure requiring peritoneal dialysis. No infectious or other etiology identified to date.


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