| VAERS ID: |
107414 (history) |
| Form: |
Version 1.0 |
| Age: |
|
| 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 / UNK |
- / - |
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), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: sudden agitation, screams, vomited frequently then died; |
