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This is VAERS ID 72450

Case Details

VAERS ID: 72450 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Foreign  
Vaccinated:1995-02-20
Onset:1995-02-21
   Days after vaccination:1
Submitted: 1995-03-23
   Days after onset:30
Entered: 1995-03-28
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Agitation, Bronchitis, Cough, Infection, Pneumonia, Pyrexia, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-02-22
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: cough syrup
Current Illness:
Preexisting Conditions: no relevant history
Allergies:
Diagnostic Lab Data: blood test-streptococcus pneumonia;
CDC Split Type: WAES95030780

Write-up: pt recvd vax & had a sl cough & cough medicine was prescribed; On 21FEB95 & exp fever of 38.6 to 38.7; 22FEB95 woke in the morning crying; went to sleep again 1hr later found dead; tracheobronchitis; streptococcus pneumonia, type 10A found


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