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; |