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This is VAERS ID 107087

Case Details

VAERS ID: 107087 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1998-01-22
Onset:1998-01-23
   Days after vaccination:1
Submitted: 1998-01-23
   Days after onset:0
Entered: 1998-01-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC Split Type: TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


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