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This is VAERS ID 162585

(NOTE: This result is from the 6/14/2018 version of the VAERS database)

Case Details

VAERS ID: 162585 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2000-10-23
Onset:2000-10-23
   Days after vaccination:0
Submitted: 2000-11-17
   Days after onset:25
Entered: 2000-11-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other       Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-23
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC Split Type:

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=162585


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