| VAERS ID: |
112467 (history) |
| Form: |
Version 1.0 |
| 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 |
- / 1 |
- / - |
| HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 2 |
- / - |
| HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
| OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / 1 |
- / - |
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), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (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: ~ ()~~~In patient
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 |
