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This is VAERS ID 58817

Case Details

VAERS ID: 58817 (history)  
Form: Version 1.0  
Age: 1.9  
Sex: Female  
Location: Montana  
Vaccinated:1993-10-15
Onset:1993-10-25
   Days after vaccination:10
Submitted: 1993-12-27
   Days after onset:63
Entered: 1994-01-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 358985 / UNK - / IM A
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1043W / UNK - / IM L
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0961W / UNK - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0686B / UNK MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1993-10-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden death; atuopsy report-cause of death remains undetermined; The poss of a sudden arrhythmia based on a morphologic abnormality of the conducting system of the heart will be investigated further;


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