| VAERS ID: |
58232 (history) |
| Form: |
Version .0 |
| Age: |
2.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 0000-00-00 |
| Onset: | 1991-01-01 |
| Submitted: |
1993-12-10 |
| Days after onset: | 1074 |
| Entered: |
1993-12-14 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / - |
- / - |
Administered by: Other Purchased by: Other
Symptoms: Cardiac failure,
Cardiomyopathy,
Dyspnoea,
Electrocardiogram abnormal,
Hyperventilation,
Infection,
Myocarditis,
Pleural effusion
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1991-10-10
Days after onset: 281
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: medical hx: imperforate anus;
Allergies:
Diagnostic Lab Data: Chest x-ray JAN91: cardiomegaly/pleural effusion; ECG JAN91: cardiomegaly; ECG 18JAN91: voltage & T wave improvement; 13FEB91 ECG: extremely low voltage;
CDC Split Type: WAES93111107
Write-up: Pt recvd vax in FEB91 & devel cardiomyopathy & myocarditis; pt underwent a heart transplant; however, it was unsuccessful; 10OCT91 pt died; |
