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This is VAERS ID 29348

Case Details

VAERS ID: 29348 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-03-08
Onset:1991-03-10
   Days after vaccination:2
Submitted: 1991-03-21
   Days after onset:11
Entered: 1991-03-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 295950 / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Cardiac arrest, Cyanosis, Hypotonia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-03-12
   Days after onset: 2
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: NA~ ()~~0.00~Patient
Other Medications: Amoxil, Ventolin
Current Illness: Resolving otitis & bronchiolitis;
Preexisting Conditions: Clinically well by hx of Physical exam
Allergies:
Diagnostic Lab Data: Pt to ER & Transferred to another hospital
CDC Split Type:

Write-up: 10MAR91 child found by aunt cyanotic & "still" in crib rushed to ER Cardiac arrest-intubated & resuscitated-transferred to Hosp.


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