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This is VAERS ID 25913

Case Details

VAERS ID: 25913 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Unknown  
Vaccinated:1990-01-24
Onset:1990-01-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256960 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Encephalopathy, Infection, Lymphadenopathy, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-25
   Days after onset: 0
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See WORM for autopsy report, emergency room reports
CDC Split Type:

Write-up: Pt received DPT vacc. @ 11 a.m. 24Jan90, 25Jan90 child discovered not breathing & CPR was administered. MEDEVACed to Stormont-Vail Medical Ctr, Tokepa, pronounced dead, only symptom noted periods of "blank staring" exhibited by the child.


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