| 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; |
