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This is VAERS ID 109861

Case Details

VAERS ID: 109861 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Texas  
Vaccinated:1998-04-14
Onset:1998-04-14
   Days after vaccination:0
Submitted: 1998-04-15
   Days after onset:1
Entered: 1998-04-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


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