National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 107712

Case Details

VAERS ID: 107712 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: New Mexico  
Vaccinated:1998-02-06
Onset:1998-02-07
   Days after vaccination:1
Submitted: 1998-02-09
   Days after onset:2
Entered: 1998-02-18
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-07
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107712


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166