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This is VAERS ID 75867

Case Details

VAERS ID: 75867 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1995-05-19
Onset:1995-05-21
   Days after vaccination:2
Submitted: 1995-06-23
   Days after onset:33
Entered: 1995-07-13
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0875A / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4B61026 / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0986A / 2 LL / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0718B / 3 MO / PO

Administered by: Public       Purchased by: Unknown
Symptoms: Apnoea, Asthma, Bronchitis, Cardiac arrest, Cardiovascular disorder, Condition aggravated, Pneumonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-05-21
   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: ventolin prn, feso4 drops, ped decongestant drops;
Current Illness: nl pe; lungs clear; home nebulizer
Preexisting Conditions: asthma, pneumonia 3MAY-6MAY on in home nebulizer
Allergies:
Diagnostic Lab Data: AEMC/ER - unable to get info at this time;
CDC Split Type: PA95166

Write-up: pt recv vax;mild asthma day p/ vax;rx @ home via nebulizer x3 & APAP x 3; no h/o fever;next am was found not breathing by grandma but had weak pulse;CPR given;called 911;to er;pt died 21may95;


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