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This is VAERS ID 43529

Case Details

VAERS ID: 43529 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: South Carolina  
Vaccinated:1992-06-19
Onset:1992-06-19
   Days after vaccination:0
Submitted: 1992-07-06
   Days after onset:17
Entered: 1992-07-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 320905 / 4 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M695HL / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 2028T / UNK LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 320946 / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Cardiovascular disorder, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: pt''s sibling exp rxn w/DTp @ 2mos #1 dose;~ ()~~~In Sibling
Other Medications: Oridol
Current Illness: runny nose, no fever or chest congestion
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: bone marrow-aspirations;
CDC Split Type: SC92077

Write-up: evening of day vax given mom noticed pt pale next few days became more pale; on 6th days p/vax passed out; seen by MD who noted heart murmur & pt adm to hospital for cardiac eval; dx TEC tx w/blood tranfusion;


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