| VAERS ID: |
107414 (history) |
| Form: |
Version .0 |
| Age: |
0.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 1996-04-03 |
| Onset: | 0000-00-00 |
| Submitted: |
1998-02-02 |
| Entered: |
1998-02-11 |
| Days after submission: | 9 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM |
1611B2 / - |
- / - |
Administered by: Unknown Purchased by: Unknown
Symptoms: Agitation,
Apnoea,
Cardiac arrest,
Crying,
Lung disorder,
Rash,
Sudden infant death syndrome,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1996-05-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: sudden agitation, screams, vomited frequently then died; |
