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This is VAERS ID 603163

Case Details

VAERS ID: 603163 (history)  
Form: Version 1.0  
Age: 1.03  
Sex: Male  
Location: Georgia  
Vaccinated:2015-10-05
Onset:2015-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 4 RL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Interstitial lung disease, Laboratory test normal, Pyrexia, Sudden death, Toxicologic test normal, Viral myocarditis
SMQs:, Torsade de pointes/QT prolongation (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2015-10-08
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC Split Type:

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


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