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This is VAERS ID 36455

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 36455
VAERS Form:
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER / LEDERLE(PRAXIS) - / - - / -
MMR: MMR II / MSD - / 0 - / -

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, APNEA, HEART ARREST, EDEMA BRAIN, ACIDOSIS DIABET

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: Tracheobronchitis & bacterial pharyngitis;
Preexisting Conditions: family history of diabetes mellitus
Allergies:
Diagnostic Lab Data: serum glucose 805;WBC 23,400;Neutrophils 65%;Platelet count 481,000;Serum sodium 140;Serum potassium 6.0;serum chloride 98;serum co2 8;BUN 30;28OCT91 CXR-Peribronchial inflammation; throat cult positive for strep;CT scan-subarachnoid hem
CDC 'Split Type':

Write-up: 2 days p/vax pt was unresponsive;taken to ER 27OCT91 blood glucose level found to be 805;adm to hosp;CXR revealed peribronchial inflamm;throat cult positive for strep;dx diabetic ketoacidosis & cerebral edema;


Changed on 12/8/2009

VAERS ID: 36455 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-20 1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS - / - - / -
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. - / 0 - / -

Administered by: Public      Purchased by: Unknown Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema, FEVER, APNEA, HEART ARREST, EDEMA BRAIN, ACIDOSIS DIABET

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: Tracheobronchitis & bacterial pharyngitis;
Preexisting Conditions: family history of diabetes mellitus
Allergies:
Diagnostic Lab Data: serum glucose 805;WBC 23,400;Neutrophils 65%;Platelet count 481,000;Serum sodium 140;Serum potassium 6.0;serum chloride 98;serum co2 8;BUN 30;28OCT91 CXR-Peribronchial inflammation; throat cult positive for strep;CT scan-subarachnoid hem
CDC 'Split Type': (blank) WAES91110183

Write-up: 2 days p/vax pt was unresponsive;taken to ER 27OCT91 blood glucose level found to be 805;adm to hosp;CXR revealed peribronchial inflamm;throat cult positive for strep;dx diabetic ketoacidosis & cerebral edema;


Changed on 5/14/2017

VAERS ID: 36455 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH - / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: unk
Current Illness: Tracheobronchitis & bacterial pharyngitis;
Preexisting Conditions: family history of diabetes mellitus
Allergies:
Diagnostic Lab Data: serum glucose 805;WBC 23,400;Neutrophils 65%;Platelet count 481,000;Serum sodium 140;Serum potassium 6.0;serum chloride 98;serum co2 8;BUN 30;28OCT91 CXR-Peribronchial inflammation; throat cult positive for strep;CT scan-subarachnoid hem No relevant data
CDC 'Split Type': WAES91110183

Write-up: 2 days p/vax pt was unresponsive;taken Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER 27OCT91 blood w/serum glucose level found to be 805;adm to hosp;CXR revealed peribronchial inflamm;throat cult positive for strep;dx 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema; edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


Changed on 9/14/2017

VAERS ID: 36455 Before After
VAERS Form:(blank) 1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / - UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 0 1 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


Changed on 2/14/2018

VAERS ID: 36455 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


Changed on 6/14/2018

VAERS ID: 36455 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


Changed on 8/14/2018

VAERS ID: 36455 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


Changed on 9/14/2018

VAERS ID: 36455 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;


Changed on 10/14/2018

VAERS ID: 36455 Before After
VAERS Form:1
Age:1.2
Sex:Male
Location:Texas
Vaccinated:1991-10-24
Onset:1991-10-26
Submitted:1991-11-12
Entered:1991-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / -

Administered by: Public      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Diabetic ketoacidosis, Hyperglycaemia, Infection, Pyrexia, Subarachnoid haemorrhage, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1991-10-29
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC 'Split Type': WAES91110183

Write-up: Recd vax 24OCT91; 26OCT91 devel thirst, tiredness & sleepiness; 27OCT91 to ER w/serum glucose 800mg%; hospitalized; dx: diabetic ketoacidosis & cerebral edema which led to respiratory & cardiac arrest; to ICU, pt unresponsive; pt died;

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