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This is VAERS ID 793321

Case Details

VAERS ID: 793321 (history)  
Form: Version 2.0  
Age: 0.92  
Sex: Male  
Location: Foreign  
Vaccinated:2016-10-17
Onset:2016-10-01
Submitted: 0000-00-00
Entered: 2018-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 150201 / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Apathy, Crying, Encephalitis viral, Fatigue, Hepatic failure, Irritability, Lethargy, Meningitis, Opisthotonus, Pallor, Panencephalitis, Pneumonia, Pyrexia, Somnolence, Thrombocytopenia, Tremor
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (narrow), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BR0095075131812BRA010453

Write-up: Information has been downloaded from regulatory authority (BR-GLAXOSMITHKLINE-BR2017GSK076666). This spontaneous report was received from a health professional concerning a 11-month-old male patient. The patient''s medical history, concurrent conditions, concomitant therapies, historical drugs or allergies were not reported. On 17-OCT-2016, the patient was vaccinated with pneumococcal vaccine (manufacturer unknown) solution for injection, intramuscularly with reported lot number 155VPN009A (strength, dose, frequency and expiry date were not reported), measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) subcutaneously with reported lot number 015N5002 (strength, dose, frequency and expiry date were not reported) and MENJUGATE solution for injection, intramuscularly with reported lot number 150201 (strength, dose, frequency and expiry date were not reported), all three vaccines for prophylaxis. On an unspecified date in October 2016, the patient experienced meningitis, persistent crying, hepatic insufficiency, metabolic disorder, alteration in transaminase, thrombocytopenia, lethargy, pallor, apathy and bronchopneumonia. Also, on an unspecified date in October 2018, a body temperature test was performed to the patient, showing a result of more than or equal to 39 (units not provided). On 18-OCT-2016, the patient experienced prostration condition and fever. On 04-NOV-2016, the patient experienced opisthotonus, somnolence and irritability. On an unspecified date in November 2016, the patient experienced viral encephalitis, trembling in extremities, viral panencephalitis post vaccine and faraway look. Also, on an unspecified date in November 2016, a computerized tomogram head test was performed to the patient (no information was available). On an unknown date, the patient died. It was unknown if an autopsy was carried out. The reported causes of death were hepatic insufficiency and metabolic disorder, with a reported date of end of both events on 08-NOV-2016 (conflicting information). The outcome of opisthotonus, trembling in extremities, alteration in transaminases, viral panencephalitis post vaccine, faraway look, somnolence, thrombocytopenia, irritability, lethargy, pallor, apathy, bronchopneumonia, viral encephalitis, fever, meningitis and prostration condition was reported as unknown (conflicting information as the reporter determined all the aforementioned events to be serious due to death and medically significant). The outcome of crying was reported as recovered (date not provided) (conflicting information as the reporter determined the event to be serious due to death and medically significant). The causality assessment between pneumococcal vaccine (manufacturer unknown) and all the aforementioned events, was reported as unknown. The causality assessment between measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) and all the aforementioned events, was not provided. The causality assessment between MENJUGATE and all the aforementioned events, was reported as unknown. Lot number 155VPN009A is an invalid lot number for pneumococcal vaccine. Lot number 015N5002 is an invalid lot number for measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live. Reported Cause(s) of Death: Hepatic insufficiency; Metabolic disorder.


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