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This is VAERS ID 837595

Case Details

VAERS ID: 837595 (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, Vaccination complication
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: CO0095075131910COL001608

Write-up: Vaccination complication; This spontaneous report has been received from a regulatory authority, concerning to 2-year-old male patient. The patient''s medical history, concurrent conditions and concomitant medications were not provided. On an unknown date, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown) dose reported as 3 (frequency, route, lot number, expiration date and indication were not provided). On an unknown date, the patient experienced a vaccination complication as cause of death. There was unknown if autopsy was performed. The agency did not provide a causal relationship between the vaccination complication and measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (manufacturer unknown). The agency considered vaccination complication as non-serious; however, the outcome of vaccination complication was reported as fatal and upon internal review, vaccination complication was determined to be medically significant.; Reported Cause(s) of Death: vaccination complication


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