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This is VAERS ID 74166

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 74166 (history)  
Form: Version .0  
Age: 10.0  
Sex: Male  
Location: Indiana  
Vaccinated:1995-05-03
Onset:1995-05-04
   Days after vaccination:1
Submitted: 1995-05-15
   Days after onset:11
Entered: 1995-05-24
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MMR II / MSD 1249A / 1 - / -

Administered by: Other       Purchased by: Unknown
Symptoms: APNEA, ASTHMA, BRONCHITIS, CONVULS, HEART ARREST
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-05
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood sugars of 800 and 400; 5MAY95 serum glucose 400-800;
CDC Split Type:

Write-up: pt recv vax 3MAY95 & 4MAY95 pt exp dizziness, tiredness; that evening, pt awoke & stated that felt bad & exp nausea; pt got into bed w/mom & began shaking which was felt to be a poss sz; pt taken to ER & was found to be in cardiac arrest


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