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This is VAERS ID 116613

Case Details

VAERS ID: 116613 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Ohio  
Vaccinated:1998-09-17
Onset:1998-09-23
   Days after vaccination:6
Submitted: 1998-11-06
   Days after onset:44
Entered: 1998-11-23
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M240RL / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1679E / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0792H / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Brain oedema, Cardiac arrest, Cardiovascular disorder, Infection, Sepsis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy performed to determine COD sepsis & salmonella serotype B infect;
CDC Split Type: OH98097

Write-up: no adverse signs or symptom were observed by parent p/immun;


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