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This is VAERS ID 25569

Case Details

VAERS ID: 25569 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Illinois  
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 1990-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Chest pain, Electrocardiogram abnormal, Myocarditis
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: no relevant history
Diagnostic Lab Data: Autopsy revealed a grossly normal pancreas. Additional info. requested.
CDC Split Type: WAES90060971

Write-up: Pt vacc. /w Mumpsvax 1st dose in response to local mumps epidemic, 2 wks later he developed chest pain & abnormal ECG. Admitt to hospital & died 2 days later /p admission /w DX of myocarditis.MD could not establish a causal relationship.

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