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This is VAERS ID 109218

Case Details

VAERS ID: 109218 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1998-01-23
Onset:1998-01-23
   Days after vaccination:0
Submitted: 1998-02-20
   Days after onset:28
Entered: 1998-04-03
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


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