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This is VAERS ID 57905

Case Details

VAERS ID: 57905 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Michigan  
Vaccinated:1993-06-14
Onset:1993-06-15
   Days after vaccination:1
Submitted: 1993-09-20
   Days after onset:97
Entered: 1993-12-06
   Days after submission:77
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1219A / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M15JL / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0118W / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-06-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: Lt conjunctivitis;
Preexisting Conditions: allergy to PCN, single febrile sz @ 14mo; functional heart murmur grad II;
Allergies:
Diagnostic Lab Data:
CDC Split Type: MI93130

Write-up: pt was seen in office for well child exam & updating immun; pt was found to be in good hlth by MD x/for eye infect; pt appeared normal that noc; following AM pt was found dead in bed;


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