| VAERS ID: |
151619 (history) |
| Form: |
Version 1.0 |
| Age: |
0.2 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2000-04-10 |
| Onset: | 0000-00-00 |
| Submitted: |
2000-04-26 |
| Entered: |
2000-05-05 |
| Days after submission: | 9 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM |
919A2 / 1 |
RL / IM |
| HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. |
1975J / 1 |
LL / IM |
| IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. |
R02352 / 1 |
RL / SC |
Administered by: Public Purchased by: Public
Symptoms: Acidosis,
Cardiac arrest,
Cardiac failure,
Dehydration,
Diarrhoea,
Hyperkalaemia,
Pleural effusion,
Pyrexia,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2000-04-17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC Split Type:
Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia |
