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This is VAERS ID 466326

Case Details

VAERS ID: 466326 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Maryland  
Vaccinated:2012-09-10
Onset:2012-09-14
   Days after vaccination:4
Submitted: 2012-09-25
   Days after onset:11
Entered: 2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Unknown       Purchased by: Public
Symptoms: Influenza virus test negative, Intensive care, Nasopharyngitis, Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC Split Type:

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


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