| VAERS ID: |
116883 (history) |
| Form: |
Version 1.0 |
| Age: |
1.2 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 1998-04-24 |
| Onset: | 1998-04-28 |
| Days after vaccination: | 4 |
| Submitted: |
1998-11-02 |
| Days after onset: | 188 |
| Entered: |
1998-11-27 |
| Days after submission: | 25 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES |
0927950 / 1 |
- / IM |
| HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES |
0927950 / 1 |
- / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0026H / 1 |
- / - |
Administered by: Private Purchased by: Private
Symptoms: Bradycardia,
Cyanosis,
Dehydration,
Diarrhoea,
Lung disorder,
Pulmonary oedema,
Shock,
Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1998-04-30
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy revealed dehydration w/moderate WBC''s in CSF;
CDC Split Type:
Write-up: child devel gastroenteritis 4 days p/vax; probably unrelated-devel worsening emesis & diarrhea over 2 days;despite intervention, pt subsequently went into shock & was taken to ER blue & pulseless; |
