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This is VAERS ID 836357

Case Details

VAERS ID: 836357 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL013117

Write-up: death; Information has been received from the Health Agency (#2019PVCL1434) on 20-SEP-2019. This spontaneous report was received from a regulatory authority and refers to a 2-year-old male patient. Patient''s concurrent conditions, concomitant therapies, previous drug reactions, allergies, historical drugs or medical history were not reported. On an unknown date, the patient started therapy with with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) (formulation, strength, dose, frequency, route of administration, anatomical location, indication, lot #, and expiration date were not reported). On an unknown date, the patient die. The outcome of death was reported as fatal. The causal relationship between death and measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) was not reported.


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