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This is VAERS ID 33613

Case Details

VAERS ID: 33613 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1991-07-24
Onset:1991-07-25
   Days after vaccination:1
Submitted: 1991-08-07
   Days after onset:13
Entered: 1991-08-12
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES DTP271 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M115HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298952 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Infection, Shock
SMQs:, Anaphylactic reaction (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Blood culture- H. Flu
CDC Split Type:

Write-up: Pt presented in Septic shock w/ DIC around MN on day of receiving 1st set of immun; Pt blood grew H. Flu from blood culture;


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