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This is VAERS ID 114109

Case Details

VAERS ID: 114109 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Idaho  
Vaccinated:1998-06-16
Onset:1998-06-24
   Days after vaccination:8
Submitted: 1998-08-27
   Days after onset:64
Entered: 1998-09-14
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 449098 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2428A2 / 2 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1295 / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Conjunctivitis, Drug ineffective, Infection, Influenza, Lymphadenopathy, Neoplasm, Pneumonia, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Severe cutaneous adverse reactions (broad), Lack of efficacy/effect (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Non-haematological tumours of unspecified malignancy (narrow), Infective pneumonia (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-24
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive haemophilus influenzae cult both lung (autopsy);
CDC Split Type: ID98039

Write-up: pt died 24JUN98;death certificate lists haemophilus influenzae/interstitial pneumonia;pt asymptomatic noc a/death;found dead in AM;SIDS ruled out ?;


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