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This is VAERS ID 80949

Case Details

VAERS ID: 80949 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Male  
Location: Connecticut  
Vaccinated:1996-01-11
Onset:1996-01-15
   Days after vaccination:4
Submitted: 1996-01-15
   Days after onset:0
Entered: 1996-01-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH M265L5 / 4 RL / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1320A / 1 LL / -

Administered by: Private       Purchased by: Private
Symptoms: Chills, Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-01-15
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EMTS w/ lividity & rigor
CDC Split Type:

Write-up: pt recvd vax 11JAN96 & exp emesis on 11JAN;well 12JAN;14NOV diarrhea stool;put to bed 14NOV & found DOA 7AM 15NOV by parents;


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