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This is VAERS ID 108072

Case Details

VAERS ID: 108072 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: New Mexico  
Vaccinated:1998-02-23
Onset:1998-02-25
   Days after vaccination:2
Submitted: 1998-03-02
   Days after onset:5
Entered: 1998-03-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC Split Type:

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


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