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This is VAERS ID 112251

Case Details

VAERS ID: 112251 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:1998-05-05
Onset:1998-05-06
   Days after vaccination:1
Submitted: 1998-06-23
   Days after onset:48
Entered: 1998-07-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 420629 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 45190 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0212 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-06
   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: Dimetapp;pt recv HBV 22MAR98;
Current Illness: Trismy 5, nasal congestion
Preexisting Conditions: Trisomy 5;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt reported by mom to have turned blue in car seat p/coming from hosp visit;911 called CPR done pt was taken to hosp;


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