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This is VAERS ID 43261

Case Details

VAERS ID: 43261 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Arizona  
Vaccinated:1991-08-28
Onset:1991-09-06
   Days after vaccination:9
Submitted: 1992-06-04
   Days after onset:272
Entered: 1992-06-30
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-had to wait 8 wks for report;
CDC Split Type:

Write-up:


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