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This is VAERS ID 150185

Case Details

VAERS ID: 150185 (history)  
Form: Version 1.0  
Age: 51.0  
Sex: Female  
Location: New York  
Vaccinated:1995-03-01
Onset:1995-04-01
   Days after vaccination:31
Submitted: 2000-03-15
   Days after onset:1810
Entered: 2000-03-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abasia, Arthralgia, Arthritis, Autoimmune disorder, Blood creatine phosphokinase increased, Connective tissue disorder, Dyspnoea, Respiratory failure, Sepsis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dystonia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (narrow), Respiratory failure (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2000-04-29
   Days after onset: 1854
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Antibiotics
Current Illness: MTI - malignant teratoma intermediate
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CPK - severely elevated.
CDC Split Type:

Write-up: Pt began suffering pain in her joints shortly after receiving vax. Dx as arthritis, then connective tissue disorder, then auto immune deficiency. She had trouble breathing, can''t walk. The pt died on 4/29/00, no autopsy will be performed. Per the death certificate the pt''s cause of death was septic shock and respiratory failure.


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