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From the 6/14/2018 release of VAERS data (an older release, current is 2/18/2021):

This is VAERS ID 162016

Case Details

VAERS ID: 162016 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Ohio  
   Days after vaccination:4
Submitted: 2000-11-08
   Days after onset:2
Entered: 2000-11-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Bradycardia, Cyanosis, Encephalopathy, Hypotension, Hypoxia, Laboratory test abnormal, Pyrexia, Tachycardia, Tonic clonic movements
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

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~Pneumo (Prevnar)~1~0.00~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, GERD and presumed sepsis; profound hypothyroidism
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:

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 desats 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 over 140''s. Decision was made to send him to PICU. He had IV placed and during which time he was given CPAP via bagging, 0.4mg of MSO4 given, intubation was 1st attempted by resident MD with attending supervision. After placement of ETT, we were unable to hear good breath sounds and pt had poor color, so tube was pulled, NG place, pt continued to be bagged back to 100%. No epinephrine was given (HR recovered by the time epi was drawn up). After this report was prepared, I was called back into the pt''s room, because he became tonic with mouth movements. Was given valium and pt''s extremities relaxed. At about the same time, his BP was found to be low, MAPs 30-40. NS bolus of 20/kg given. On 60-day followup: pt was transferred to ICU where he got slightly better, then worse again. He died 12/2000. The pt was medically fragile and because his decompensation occurred after DTAP I reported it. Believes his decompensation is multifactorial and not related to vaccines alone.

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