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This is VAERS ID 155775

Case Details

VAERS ID: 155775 (history)  
Form: Version 1.0  
Age: 1.25  
Sex: Male  
Location: New Mexico  
Vaccinated:2000-06-09
Onset:2000-06-17
   Days after vaccination:8
Submitted: 2000-06-20
   Days after onset:3
Entered: 2000-06-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC Split Type:

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


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