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This is VAERS ID 160612

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 160612 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:1997-11-11
Onset:1997-11-12
   Days after vaccination:1
Submitted: 2000-10-10
   Days after onset:1062
Entered: 2000-10-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, High-pitched crying, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Platelet count increased, Pneumonia, Pyrexia, Respiratory arrest
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Convulsions (narrow), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1997-11-29
   Days after onset: 17
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC Split Type:

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


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