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VAERS ID: | 239968 |
VAERS Form: | |
Age: | 1.0 |
Sex: | Female |
Location: | Ohio |
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, | UE118AA / 3 | RL / IM |
MMR: MEASLES MUMPS RUBELLA (VIRIVAC) / MERCK & CO. INC. | 0821N / 0 | LA / SC |
PPV: PNEUMO, 23-VALENT (PNU-IMUNE) / LEDERLE LABORATO | A74399K / 2 | LL / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: AGITATION, BRADYCARDIA, DEHYDRAT, COUGH INC, EDEMA BRAIN
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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. Blo"od sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, AVENTIS PASTEUR | UE118AA / 3 | RL / IM |
MMR: MEASLES MUMPS RUBELLA (VIRIVAC) MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. | 0821N / 0 | LA / SC |
PPV: PNEUMO, 23-VALENT (PNU-IMUNE) PNEUMO (PNU-IMUNE) / LEDERLE LABORATO LEDERLE LABORATORIES | A74399K / 2 | LL / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema, AGITATION, BRADYCARDIA, DEHYDRAT, COUGH INC, EDEMA BRAIN
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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. Blo"od Blood sugar 700+ Dx: Diabetic Ketoacidosis. Life flight to Hosp. Brain stem swelling. Pt died 10/24 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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR | UE118AA / 3 | RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. | 0821N / 0 | LA / SC |
PPV: PNEUMO (PNU-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH | A74399K / 2 | LL / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UE118AA / 3 4 | RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (VIRIVAC) / MERCK & CO. INC. | 0821N / 0 1 | LA / SC |
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH | A74399K / 2 3 | LL / IM |
Administered by: Unknown Purchased by: Unknown
Symptoms: Blood glucose increased, Bradycardia, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
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, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
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, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
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, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
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, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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.
Vaccinated: | 2004-10-19 |
Onset: | 2004-10-21 |
Submitted: | 2004-11-09 |
Entered: | 2005-06-16 |
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, Cough, Dehydration, Hyponatraemia, Hypoventilation, Irritability, Ketoacidosis, Lethargy, Pain, Pallor, Pneumonia, Polyuria, Pyrexia, Tachycardia, Weight decreased, Brain oedema
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2
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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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=239968&WAYBACKHISTORY=ON
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