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This is VAERS ID 85217

Case Details

VAERS ID: 85217 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: Arkansas  
Vaccinated:1996-02-29
Onset:1996-03-08
   Days after vaccination:8
Submitted: 1996-03-25
   Days after onset:17
Entered: 1996-04-24
   Days after submission:29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429965 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0887D / 1 LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Bronchitis
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: ATB
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: info recv for death certificate that pt had a resp arrest & acute bronchitis;parents refused autopsy according to funeral director


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