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This is VAERS ID 160203

Case Details

VAERS ID: 160203 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: Illinois  
Vaccinated:2000-08-31
Onset:2000-09-01
   Days after vaccination:1
Submitted: 2000-09-01
   Days after onset:0
Entered: 2000-09-29
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1489 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Cardiac arrest, Hypernatraemia, Respiratory arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt was brought into the ER in full cardio respiratory arrest. Autopsy states cause of death as hypernatremia.


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