| VAERS ID: |
112467 (history) |
| Form: |
Version .0 |
| Age: |
0.4 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 1998-04-22 |
| Onset: | 1998-04-23 |
| Days after vaccination: | 1 |
| Submitted: |
1998-07-09 |
| Days after onset: | 77 |
| Entered: |
1998-07-13 |
| Days after submission: | 4 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 0 |
- / - |
| HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
| HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 0 |
- / - |
| OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 0 |
- / - |
Administered by: Public Purchased by: Other
Symptoms: Agitation,
Chills,
Constipation,
Crying,
Diarrhoea,
Injection site hypersensitivity,
Injection site oedema,
Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-04-26
Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: w/in 7hr site of inj was swollen & reddish for next 12hr pt alternately screamed inconsolably & fell into a deep sleep, next day had diarrhea & tool longer to finish bottles, as day went by skin felt cold to touch;pt later died;constipation |
