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This is VAERS ID 477186

Case Details

VAERS ID: 477186 (history)  
Form: Version 1.0  
Age: 1.06  
Sex: Female  
Location: Unknown  
Vaccinated:1994-11-01
Onset:1994-11-01
   Days after vaccination:0
Submitted: 2012-12-07
   Days after onset:6611
Entered: 2012-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Blindness, Death, Immune system disorder, Pyrexia, Surgery
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 1993, Body temperature, 107-108 F
CDC Split Type: WAES1212USA001673

Write-up: This spontaneous report was received from the patient''s brother refers to a 13 months old female patient with no pertinent Medical History or Drug reactions/allergies who on unspecified date in approximately November 1994 (when the patient was 13 months of age) was vaccinated with MMR II (dose, lot number and route no reported). No other co-suspects were reported. No concomitant medications were reported. The night the patient received the vaccine, the patient developed a high fever (107-108 F) and was sent to an unspecified hospital where she was admitted and treated for an unspecified period of time. On unknown date, the patient had multiple unspecified surgeries, became blind and her "immune system failed." The patient was two years of age when she died (approximately in 1995). The outcome of the events patient developed a high fever (107-108 F), became blind and her "immune system failed" was unknown. The relatedness for the event and MMR II was unknown. Additional information is not expected.


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