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This is VAERS ID 28528

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 28528 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-02-18
Onset:1991-02-18
   Days after vaccination:0
Submitted: 1991-02-19
   Days after onset:1
Entered: 1991-03-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M635FN / 3 - / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-18
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Digoxin, aspirin
Current Illness:
Preexisting Conditions: Congental Heart Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3790

Write-up: Expired p/having sz. Occurred 5 hrs post vax.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=28528


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