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This is VAERS ID 47460

Case Details

VAERS ID: 47460 (history)  
Form: Version 1.0  
Age: 1.8  
Sex: Male  
Location: Montana  
Vaccinated:1992-10-13
Onset:1992-10-27
   Days after vaccination:14
Submitted: 1992-11-10
   Days after onset:14
Entered: 1992-11-24
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 322915 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0055T / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0652K / 3 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Dyspnoea, Infection, Meningitis, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious meningitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1992-10-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: URI-no temp
Preexisting Conditions: normal
Allergies:
Diagnostic Lab Data: lab tests completed @ hosp 27OCT92;
CDC Split Type: MT92027

Write-up: pt was admitted to hosp on 27OCT92 for pneumonia began to devel resp problems & was transferred to another hosp on 27OCT92; dx Haemophilus Influenza meningitis & died 27OCT92;


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