| VAERS ID: |
70595 (history) |
| Form: |
Version 1.0 |
| Age: |
1.2 |
| Sex: |
Male |
| Location: |
Foreign |
| Vaccinated: | 1994-10-25 |
| Onset: | 1994-11-05 |
| Days after vaccination: | 11 |
| Submitted: |
1995-01-10 |
| Days after onset: | 66 |
| Entered: |
1995-01-17 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
- / 1 |
- / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Adrenal haemorrhage,
Adrenal insufficiency,
Dyspnoea,
Infection,
Petechiae,
Sepsis,
Shock,
Tachycardia
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Dehydration (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1994-11-06
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no relevant hx
Allergies:
Diagnostic Lab Data: no relevant data
CDC Split Type: WAES94120828
Write-up: pt recvd vax;5nov94 suddenly devel fever 39.8C,tachycardia,v,petechial hemorrhages;pt adm to hosp;on 6nov94 died;COD was septic multiorgan failure;there was a suspiscion of meningococcal toxemia w/ picture of Waterhouse-Friedr synd; |
