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This is VAERS ID 112990

Case Details

VAERS ID: 112990 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Missouri  
Vaccinated:1998-07-01
Onset:1998-07-11
   Days after vaccination:10
Submitted: 1998-07-15
   Days after onset:4
Entered: 1998-08-03
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1357D / 1 - / -

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Cyanosis, Malaise, Meningitis, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-13
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MO98039

Write-up: 11JUL98 pt began running fever & vomited once;mom gave APAP & fever went down;12JUL98 pt was sick & fussy in morning;by noon, pt had hands & lips turning blue;went to ER:13JUL98 pt died of meningococcal meningitis;


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