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This is VAERS ID 26694

Case Details

VAERS ID: 26694 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Tennessee  
Vaccinated:1990-09-10
Onset:0000-00-00
Submitted: 1990-11-16
Entered: 1990-11-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285968 / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283949 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Depressed level of consciousness, Encephalitis, Subarachnoid haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-13
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: Chronic CNS Disease
Preexisting Conditions: Subarachnoid hemorrhage & encephalomalacia
Allergies:
Diagnostic Lab Data: Prior CT scans showed subarachnoid hemorhage; encephalomalacia.
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV then died 13OCT90 from respiratory arrest secondary to severe central nervous system disease which antedated immunization. Immunizations not felt to be related to death.


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