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This is VAERS ID 31738

Case Details

VAERS ID: 31738 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Alaska  
Vaccinated:1991-02-25
Onset:1991-03-06
   Days after vaccination:9
Submitted: 1991-06-20
   Days after onset:105
Entered: 1991-06-24
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Private       Purchased by: Other
Symptoms: Bradycardia, CSF test abnormal, Condition aggravated, Drug ineffective, Hypotension, Infection, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-10
   Days after onset: 34
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ceftriaxone, Rifampin, Phenobarbital
Current Illness:
Preexisting Conditions: Down''s synd, Tetralogy of fallot, Atelectasis;
Allergies:
Diagnostic Lab Data: CXR 7MAR91 RLL infiltrate, vertex Atelectas, CSF 7MAR91 Culture-negative, CSF 25MAR91 Cultur-Negative, CSF 7MAR91 - 47 RBC, 20 WBC, 80% PMN''s, 20% Lymphs, 54 PROTEIN, 41 GLUCOSE, Latex aggl HIB positive URINE, CSR 9MAR91 - HIB +;
CDC Split Type: WAES91060083

Write-up: Pt hospitalized on 1FEB91 for diarrhea, fever & breathing difficulties; Seen in ER; While hospitalized given vax & became irritable, temp 105, hypotensive, bradyarrhythmia, & poss pneumonia & died;


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