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This is VAERS ID 28327

Case Details

VAERS ID: 28327 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Louisiana  
Vaccinated:1990-12-27
Onset:1991-01-02
   Days after vaccination:6
Submitted: 1991-01-15
   Days after onset:13
Entered: 1991-02-15
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 275970 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287954 / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Dehydration, Eye disorder, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-02
   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: Tylenol
Current Illness:
Preexisting Conditions: 26 wks preme, hx of hyaline membrane disease, sepsis, necrotizing enterocolitis /w small bowel resec, malabsorption, formula intolerance
Allergies:
Diagnostic Lab Data: CSF-clear, WBC-0, RBC-5, 0-Segs & Lymphs
CDC Split Type: LA910203

Write-up: Mom noted listlessness & dark circles around eyes in am 2Jan, pt taken Hosp arrived @ 11am, found to have T 103, T escalating, pt died @ 1130 am, cause of death - dehydration, No fever noted @ time of Immun. to arrival @ hosp, no neuro S+S


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