| VAERS ID: |
76587 (history) |
| Form: |
Version .0 |
| Age: |
11.0 |
| Sex: |
Female |
| Location: |
Florida |
| Vaccinated: | 1995-03-08 |
| Onset: | 1995-04-05 |
| Days after vaccination: | 28 |
| Submitted: |
1995-08-08 |
| Days after onset: | 125 |
| Entered: |
1995-08-14 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
0455W / 0 |
LA / - |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0735P / 1 |
LA / - |
Administered by: Private Purchased by: Other
Symptoms: Aspartate aminotransferase increased,
Hepatomegaly,
Neoplasm malignant,
Pain,
Pyrexia,
Splenomegaly,
Vomiting,
Weight decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Non-haematological malignant tumours (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 1995-06-19
Days after onset: 75
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 26 days
Extended hospital stay? No
Previous Vaccinations: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: lab work done, positive for strep
CDC Split Type:
Write-up: pt recv vax;about 4-5 wk p/ vax pt c/o pain in her rt side,not better,hosp,dx w/ cancer;mom thinks vax triggered cancer;c/o pharyngitis,v,dec appetite;significant weight dec;pain abd;T 99.3;back pain;pt died from renal cell carcinoma; |
