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This is VAERS ID 26668

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 26668 (history)  
Form: Version .0  
Age: 1.4  
Sex: Unknown  
Location: New York  
Vaccinated:1990-11-08
Onset:1990-11-11
   Days after vaccination:3
Submitted: 1990-11-13
   Days after onset:2
Entered: 1990-11-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0C21132 / 0 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Laryngitis, Otitis media, Pharyngitis, Pyrexia
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-11
   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:
Current Illness: Mild cold
Preexisting Conditions: normal child
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3705

Write-up: Pt vaccinated with PROHIBIT mild cold at time of injection. Seen again 11NOV for subjective fever, worsening cold tugging at ears. Dx w/Otitis. Prescribed Augmentin, Codeine & Tylenol. Child found dead 6 hrs later in bed. Normal child


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