National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 111980

Case Details

VAERS ID: 111980 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Maryland  
Vaccinated:1998-05-11
Onset:1998-05-15
   Days after vaccination:4
Submitted: 1998-06-04
   Days after onset:20
Entered: 1998-06-19
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1568E / 1 RL / SC

Administered by: Private       Purchased by: Other
Symptoms: Infection, Meningitis, Myocarditis, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Suprax prescribed 11MAY p/vax given;
Current Illness: NONE
Preexisting Conditions: OM
Allergies:
Diagnostic Lab Data: case pending-MD medical examiners office;
CDC Split Type:

Write-up: 15MAY 6AM call from mom to report pt is unresponsive had been vomiting for 2 days & inc lethargic;advised to call 911-pt taken to hosp-resuscitation unsuccessful;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111980


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166