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This is VAERS ID 28812

Case Details

VAERS ID: 28812 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1990-12-18
Onset:1990-12-18
   Days after vaccination:0
Submitted: 1991-01-02
   Days after onset:15
Entered: 1991-03-04
   Days after submission:61
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195FD / 1 RL / IM
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 1464S / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Cardiac failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), 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? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ferinsol, Diuril until 17DEC; Nebs: Ventolin/Mucomyst
Current Illness: BPD, S/P G-Tube placement
Preexisting Conditions: 25 wk premie w/h/o BPD, Cardiorespiratory arrest; S/P tracheostomy, sepsis, blood trnafusions, subglottis stenosis.
Allergies:
Diagnostic Lab Data: ABG=6.8; PCO2=30; PO2=185; base excess of 25.8; saturated of 97.8%. Lytes p/med NA=141, K=3.1, CO2=2.4, cl=111; Glucose=486; temp 95.4; HR-166
CDC Split Type:

Write-up: @ 1030PM, monitor went off for heart & respirations; no palpable pulse; appeared to be in asystole. Rec''d Atropine & Epinephrine, bicarb; a second dose of epi & bicarb were also administered @ 10:39, faint fem pulse present; 1 BrS @ 1041


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