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This is VAERS ID 41711

Case Details

VAERS ID: 41711 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Louisiana  
Vaccinated:1992-04-01
Onset:1992-04-01
   Days after vaccination:0
Submitted: 1992-04-13
   Days after onset:11
Entered: 1992-05-04
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 4 RL / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 2189S / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M570HJ / 3 LL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0860T / UNK LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0643B12 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Hypochromic anaemia, Hypoxia, Leukopenia, Lung disorder, Lymphocytosis, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: WBC-3.3; Hgb - 8.5; HCt - 26.1; Poly-15; Lymph-77;
CDC Split Type: LA920402

Write-up: Pt brought to ER via ambulance w/CPR in progress; pt found by mom not breathing; pt recvd vax 31MAR92 & had been running fever; Resp distress;


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