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This is VAERS ID 27313

Case Details

VAERS ID: 27313 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: West Virginia  
Vaccinated:1989-07-17
Onset:1990-12-03
   Days after vaccination:504
Submitted: 1990-12-27
   Days after onset:24
Entered: 1991-01-07
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES - / UNK - / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 8J01171 / 1 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective, Immune system disorder, Meningitis, Sepsis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood Culture positive for H. Influenza type B
CDC Split Type: CO3731

Write-up: Died after developing Hib meningitis. MD sending samples to CDC for analysis. Reported that the child had some form of immune deficiency. Father told MD he also had a form of immune deficiency.


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