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This is VAERS ID 58232

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 58232 (history)  
Form: Version .0  
Age: 2.0  
Sex: Female  
Location: Illinois  
Submitted: 1993-12-10
   Days after onset:1074
Entered: 1993-12-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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;
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;

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