VAERS ID: 25010

AGE: 1.7| SEX: M|STATE: FR

Description

17 mon. male, received 29Oct89 MMR vaccine 1 dose. 21Dec89 received therapy w/ Promethazine HCL, HS. 22Dec89 infant found dead. Post mortem revealed acute Streptococcal tracheobronchitis.

Symptoms

Bronchitis

Vaccines

VAX DATE: 10-29-1989| ONSET DATE: 12-01-1989| DAYS TO ONSET: 33
NameDose #TypeManufacturerLotRouteSite
MEASLES + MUMPS + RUBELLA (MMR II) Unknown MMR MERCK & CO. INC. A2223P Unknown Unknown

RECVDATE:07-02-1990
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Dianostic test - Autopsy, Date Dec89 , comment - Streptococcal tracheobronchitis
V_ADMINBY:PVT
OTHER_MEDS:Promethanzine HCL given 21Dec89-21Dec89
CUR_ILL:
HISTORY:
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:WAES90060362
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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