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This is VAERS ID 44528

Case Details

VAERS ID: 44528 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Kansas  
Vaccinated:1992-07-24
Onset:1992-07-24
   Days after vaccination:0
Submitted: 1992-08-18
   Days after onset:25
Entered: 1992-08-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2H31068 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1002A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M700AE / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0648L / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Cyanosis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (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, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: circumoral pallor & cyanosis, passed out lasting few seconds; pt hospitalized;


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