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This is VAERS ID 162016

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

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


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