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|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
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
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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