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This is VAERS ID 96398

Case Details

VAERS ID: 96398 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Tennessee  
Vaccinated:1997-02-18
Onset:1997-02-26
   Days after vaccination:8
Submitted: 1997-02-27
   Days after onset:1
Entered: 1997-03-21
   Days after submission:22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434814 / 4 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0393D / 1 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-02-26
   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: ?
Current Illness: unk
Preexisting Conditions: premie-7wk early followed @ hosp
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN97018

Write-up: death-asthma attack in MD office 26FEB97 & expired;had gone to hosp 25FEB97 to MD;


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