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This is VAERS ID 112938

Case Details

VAERS ID: 112938 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: New Jersey  
Vaccinated:1997-11-05
Onset:1998-01-02
   Days after vaccination:58
Submitted: 1998-07-23
   Days after onset:201
Entered: 1998-07-30
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444256 / 4 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0775A / 3 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anorexia, Apnoea, Diarrhoea, Rash
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nigerol
Current Illness: yeast infect
Preexisting Conditions: ear infect, devel delay physically, gag reflex disorder;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt began not eating well, had diarrhea x 1 day, devel sl rash on face & on vaginal area;pt put down for a nap-was found in bed not breathing, pronounced dead @ hosp;


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