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This is VAERS ID 29463

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 29463 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:1991-01-17
Onset:1991-01-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FD / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622D / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Apnoea, Cardiomegaly, Cyanosis, Hernia, Pallor, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Dehydration (broad)

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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: cranial synostosis & choanal atresia, & heart murmur
Allergies:
Diagnostic Lab Data:
CDC Split Type: TX9108

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=20180814&IDNUMBER=29463


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