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This is VAERS ID 29397

Case Details

VAERS ID: 29397 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1991-02-27
Onset:1991-02-28
   Days after vaccination:1
Submitted: 1991-03-08
   Days after onset:8
Entered: 1991-03-27
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293948 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M2053P / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Rash, Rhinitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: None apparent
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Bloodwork & Urinalysis - normal
CDC Split Type: PA9186

Write-up: Fever to 104 27FEB91 & 105 28FEB91; To ER 28FEB91; No apparent infect; Had red blotching on face 1MAR91 p/taking Augmentin was discontinued due to poss allergy; continues to have low grade fever & has clear nasal discharge.


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