National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/7/2022 release of VAERS data:

This is VAERS ID 121006

Government Disclaimer on use of this data



Case Details

VAERS ID: 121006 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1999-03-20
Onset:1999-03-28
   Days after vaccination:8
Submitted: 1999-04-06
   Days after onset:8
Entered: 1999-04-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456819 / 1 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0998900 / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-03-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: Tobrex eye drops
Current Illness: conjunctivitis
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt died 28MAR99;pt recv vax30AR99;no other adverse reactions were reported;found in crib apneic & pulseless;taken to hosp & tried to be resuscitated but unsuccessful;


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=121006


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166