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This is VAERS ID 159083

Case Details

VAERS ID: 159083 (history)  
Form: Version 1.0  
Age: 1.08  
Sex: Female  
Location: New Hampshire  
Vaccinated:2000-08-15
Onset:2000-08-15
   Days after vaccination:0
Submitted: 2000-08-16
   Days after onset:1
Entered: 2000-08-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3199A2 / 3 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1450J / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Blood disorder, Blood glucose increased, Bradycardia, Cyanosis, Haemolysis, Hypoxia, Pyrexia, Respiratory arrest, Vomiting
SMQs:, Haemolytic disorders (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic cytopenias affecting more than one type of blood cell (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-08-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Catopril, Digoxin, Lasix
Current Illness: NONE
Preexisting Conditions: Tricuspid atresia, pulmonary atresia, unrestricted ASD
Allergies:
Diagnostic Lab Data: CBC, WBC, BUN, H/H-17.7/52.3, GLU-165
CDC Split Type:

Write-up: The pt developed a fever and vomiting with cyanosis on evening of immunization. In the ER the pulse ox was 50% (normal for her is 78). The pt developed bradycardia and respiratory arrest. Full CPR performed for 70-80 minutes before pronounced.


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