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This is VAERS ID 837593

Case Details

VAERS ID: 837593 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2019-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Septic shock
SMQs:, Toxic-septic shock conditions (narrow), Sepsis (narrow), Opportunistic infections (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO0095075131910COL001479

Write-up: septic shock; Information was received from Health Authority (agency number was not provided), referring to a 2 years old male patient. The patient''s medical history, concurrent conditions, previous drug reactions, allergies and concomitant medications were not reported. On an unknown date, the patient was vaccinated with Measles, Mumps, and Rubella (Wistar RA 27-3) Virus Vaccine, Live (manufacturer unknown) on a dose reported as 3 (units not reported) for prophylaxis (frequency, route of administration, lot number and expiration date were not reported). On an unknown date, the patient experienced septic shock. The outcome of septic shock was reported as fatal. The reporter''s causality assessment between the septic shock and Measles, Mumps, and Rubella (Wistar RA 27-3) Virus Vaccine, Live (manufacturer unknown) was not reported. Upon internal review, the septic shock was considered serious due to death seriousness criteria.


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