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This is VAERS ID 108787

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 108787 (history)  
Form: Version .0  
Age: 0.4  
Sex: Female  
Location: North Carolina  
Vaccinated:1998-01-28
Onset:1998-01-28
   Days after vaccination:0
Submitted: 1998-03-12
   Days after onset:43
Entered: 1998-03-23
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 446956 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M260RJ / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / - - / -

Administered by: Military       Purchased by: Military
Symptoms: Brain oedema, Haemorrhage, Meningitis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Noninfectious meningitis (narrow), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-07
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient died;COD unk by reporter;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=108787


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