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This is VAERS ID 111826

Case Details

VAERS ID: 111826 (history)  
Form: Version 1.0  
Age: 79.0  
Sex: Female  
Location: Ohio  
Vaccinated:1998-05-19
Onset:1998-05-23
   Days after vaccination:4
Submitted: 1998-06-09
   Days after onset:17
Entered: 1998-06-15
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 0922800 / 1 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Confusional state, Diarrhoea, Dyspnoea, Myocarditis, Renal failure, Sepsis, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U199800261

Write-up: pt recv vax 19MAY98 & 4 days later pt exp diarrhea, confusion & abd pains;some time later the pt exp resp distress, renal failure, myocarditis & septic shock;pt seen by MD & sent to ER:pt adm to ICU;1JUN98 pt still on ventilator-stable;


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