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This is VAERS ID 74166

(NOTE: This result is from the 12/8/2009 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: 1995-05-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1249A / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Convulsion, Hyperglycaemia, Malaise, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Convulsions (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad)

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: WAES95050372

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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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=74166


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