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This is VAERS ID 74166

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 74166 (history)  
Form: Version 1.0  
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 / 2 - / -

Administered by: Other       Purchased by: Other
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), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (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=20181014&IDNUMBER=74166


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