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This is VAERS ID 106654

Case Details

VAERS ID: 106654 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: New York  
Vaccinated:1998-01-05
Onset:1998-01-18
   Days after vaccination:13
Submitted: 1998-01-19
   Days after onset:1
Entered: 1998-01-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1160E / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Dyspnoea, Encephalitis, Malaise, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-01-19
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: MD notified @ home from ER-parents heard pt gasp-pt having sz-pt taken to ER where died;


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