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This is VAERS ID 78670

Case Details

VAERS ID: 78670 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: New York  
Vaccinated:1995-05-24
Onset:1995-06-06
   Days after vaccination:13
Submitted: 1995-10-31
   Days after onset:147
Entered: 1995-11-06
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0640A / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0552A / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Convulsion, Delirium, Encephalopathy, Pallor, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-06-10
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: p/receiving vax feverish & very pale-took pt for blood work 4 days prior to death-due to paleish face;went into a sx disorder & went into cardiac arrest was pronounced dead on arrival;


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