VAERS ID: |
162016 (history) |
Form: |
Version .0 |
Age: |
0.3 |
Sex: |
Male |
Location: |
Ohio |
Vaccinated: | 2000-11-02 |
Onset: | 2000-11-06 |
Days after vaccination: | 4 |
Submitted: |
2000-11-08 |
Days after onset: | 2 |
Entered: |
2000-11-17 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: ACEL-IMUNE / LEDERLE |
467007 / 1 |
- / IM |
HIBV: ACT-HIB / CONNAUGHT LABS |
468397 / 1 |
- / IM |
IPV: POLIOVAX / CONNAUGHT LTD |
P1412 / 1 |
- / SC |
Administered by: Private Purchased by: Unknown Symptoms: APNEA,
BRADYCARDIA,
CYANOSIS,
ENCEPHALOPATHY,
FEVER SMQs:
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 0000-00-00
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations: Respiratory compromise;PREVNAR;1;.00;In Patient Other Medications: Diuril, Lasix, NaC1 supplements, Zantac, Reglan, Fe therapy, Augmentin, Synthroid, albuterol, Atrovent, Aldactone, Intal, Synagis/Med-Immune/IM/0 previously Current Illness: pneumonia Preexisting Conditions: Premature at 28 weeks gestation, delivered in ambulance and given blow-by O2 en route. He was treated for narcotic withdrawal, apneas, bradycardias, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, hyperbilirubinemia, anemia, Allergies: Diagnostic Lab Data: CBC-5.5 with 86 polys, 6 lymphs, 7 monos, 1 eos; UA-nml; CBG-7.28/PC02 110/Bicarb 49 CDC Split Type: Premature at 28 weeks gestation, delivered in ambulance and given blow-by O2 en route. He was treated for narcotic withdrawal, apneas, bradycardias, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, hyperbilirubinemia, anemia,
Write-up: Encephalopathy within 7days of DTAP. (See attached). Early AM of 11/6, he spiked a fever of 38.4C. He was noted to be bradycardic during the blood draw but recovered immediately. He was also noted to have apnea lasting up to 20 seconds, associated with de"sats down to high 80''''s while on O2. At 13:30, RN responded to apnea alarm. He was not breathing and sats were down to 50''''s. He was stimulated and MD was called. He continued to be apneic, by this time sats down to 30''''s with dusky color. HR remained ove |