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This is VAERS ID 239968

Case Details

VAERS ID: 239968 (history)  
Form: Version 1.0  
Age: 1.04  
Sex: Female  
Location: Ohio  
Vaccinated:2004-10-19
Onset:2004-10-21
   Days after vaccination:2
Submitted: 2004-11-09
   Days after onset:19
Entered: 2005-06-16
   Days after submission:218
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE118AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. 0821N / 1 LA / SC
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH A74399K / 3 LL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Brain oedema, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Slight Cough - T99.8 - Lungs clear
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Blood sugars, Blood tests, X-rays
CDC Split Type:

Write-up: Had been to MD week of 10/18 with normal well child exam. 10/19/2004 slight cough, chest clear temp 99.8 in our office. To MD office 10/21/04 - Dx beginning pneumonia. Antibiotic inj. given and sent home. 10/22/04 Rapid progression of pneumonia at ER. Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24. Added code of dehydration from Death Certificate rec''d 06/13/2005. From discharge Summary rec''d 06/21/2005, added terms are polyuris, lethargy, weight loss, tachycardia, dehydration, irritable, bradycardia, hypoventilation, pain, hyperventilation, pallow, and hyponatremia.


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