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This is VAERS ID 113477

Case Details

VAERS ID: 113477 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: American Samoa  
Vaccinated:1998-07-29
Onset:1998-07-29
   Days after vaccination:0
Submitted: 1998-08-03
   Days after onset:5
Entered: 1998-08-18
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0789E / 1 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cyanosis, Dyspnoea, Lymphocytosis, Pyrexia, Sepsis, Shock
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-30
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COD uncertain;
CDC Split Type:

Write-up: pt recv vax & became feverish & fussy that afternoon (5-6 hr later) but still feeding;to ER 30JUL98 w/severe resp distress, grunting, cyanosis, drawing in of chest, semi-comatose shock, afeb;intubated;WBC 49.2, segs polys 33%,lymph 61%;


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