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This is VAERS ID 29463

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 29463 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-17
Onset:1991-01-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 289963 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M200FD / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0622D / 0 - / PO

Administered by: Public       Purchased by: Unknown
Symptoms: AGITATION, APNEA, CARDIOMEGALY, CYANOSIS, HERNIA
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-02
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: P/immun given client started to cry & then became apneic; PR noted 126; Apnea lasted only 15-20sec- raised lt arm & client responded imm; color ashen; DX w/hyperplastic heart: prognosis poor;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=29463


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