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This is VAERS ID 259249

Case Details

VAERS ID: 259249 (history)  
Form: Version 1.0  
Age: 0.36  
Gender: Male  
Location: Alabama  
Vaccinated:2006-06-21
Onset:2006-06-24
   Days after vaccination:3
Submitted: 2006-07-03
   Days after onset:9
Entered: 2006-07-06
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE650AB / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1050 / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08653F / 2 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC Split Type:

Write-up: Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


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