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This is VAERS ID 112811

Case Details

VAERS ID: 112811 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Oregon  
Vaccinated:1998-07-10
Onset:1998-07-11
   Days after vaccination:1
Submitted: 1998-07-14
   Days after onset:3
Entered: 1998-07-22
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 455838 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Acidosis, Congenital anomaly, Heart disease congenital, Hyperkalaemia
SMQs:, Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Congenital, familial and genetic disorders (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1998-07-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Reglan, Digoxin
Current Illness: s/p transposition repair @ birth
Preexisting Conditions: congenital heart defect;
Allergies:
Diagnostic Lab Data: metabolic acidosis & hyperkalemia;
CDC Split Type:

Write-up: in less than 24hr of vax pt died-presumably of rt heart ischemia secondary to repair of transposition of the great vessels @ birth;


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