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This is VAERS ID 108647

Case Details

VAERS ID: 108647 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: California  
Vaccinated:1998-03-13
Onset:1998-03-14
   Days after vaccination:1
Submitted: 1998-03-16
   Days after onset:2
Entered: 1998-03-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Agranulocytosis (broad), Oropharyngeal infections (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-14
   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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA980032

Write-up: pt died less than 24hr p/vax;


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