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This is VAERS ID 26484

Case Details

VAERS ID: 26484 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: California  
Vaccinated:1990-09-27
Onset:0000-00-00
Submitted: 1990-10-30
Entered: 1990-11-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / 4 - / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES - / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 3 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Chills, Pain, Pyrexia, Vasodilatation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-06
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/HIB/MMR found apneic in crib on 06OCT90.


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