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This is VAERS ID 96570

Case Details

VAERS ID: 96570 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Female  
Location: Arizona  
Vaccinated:1997-02-26
Onset:1997-02-28
   Days after vaccination:2
Submitted: 1997-03-19
   Days after onset:19
Entered: 1997-03-31
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 440644 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1314B / 1 RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Somnolence, Urinary incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-03-03
   Days after onset: 3
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: fever, cough 2 days afeb 26FEB97
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy results pending;
CDC Split Type:

Write-up: pt began vomiting on 28FEB97 t/c to MD on call 2MAR97 711PM describes vomiting no diarrhea no blood in vomit;urinating, sleeping but easily arousable;advice given w/instructions to call back if sx inc & in AM for appointment;


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