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This is VAERS ID 52579

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 52579
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 2F41092 / - - / -
HEP: HEPTAVAX / MSD 1555V / - - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M025JE / - - / -
IPV: POLIOVAX / CONNAUGHT LTD G0083 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: BRADYCARDIA, APNEA, HEART ARREST, HYPOVENTIL, HEMATEMESIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 12/8/2009

VAERS ID: 52579 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-14 1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL DTP (TRI-IMMUNOL) / LEDERLE LEDERLE LABORATORIES 2F41092 / - - / -
HEP: HEPTAVAX HEP B (HEPTAVAX) / MSD MERCK & CO. INC. 1555V / - - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M025JE / - - / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. G0083 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor, BRADYCARDIA, APNEA, HEART ARREST, HYPOVENTIL, HEMATEMESIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 8/31/2010

VAERS ID: 52579 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / - - / -
HEP: HEP B (HEPTAVAX) HEP B (FOREIGN) / MERCK & CO. INC. 1555V / - - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M025JE / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 5/14/2017

VAERS ID: 52579 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / - - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / - - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M025JE / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 9/14/2017

VAERS ID: 52579 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / - UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / - UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / - UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 2/14/2018

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 6/14/2018

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 8/14/2018

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 9/14/2018

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 10/14/2018

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 12/10/2020

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown Tennessee
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 12/24/2020

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 12/30/2020

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 5/7/2021

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);


Changed on 5/21/2021

VAERS ID: 52579 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1993-04-15
Onset:1993-04-16
Submitted:0000-00-00
Entered:1993-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 2F41092 / UNK - / -
HEP: HEP B (FOREIGN) / MERCK & CO. INC. 1555V / UNK - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M025JE / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. G0083 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cardiac arrest, Haematemesis, Hypoventilation, Pallor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness:
Preexisting Conditions: premature pt w/apnea of prematurity nearing discharge from hosp; NKA;
Allergies:
Diagnostic Lab Data: aminophylline;
CDC 'Split Type':

Write-up: pt became ashen, bradycardic, & hypoventilated; blood tinged vomitus was noted; pt was intubated & given CPR; pt did not respond to resuscitation & died; temporally related to vax administration (2hrs);

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