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This is VAERS ID 30208

Case Details

VAERS ID: 30208 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Ohio  
Vaccinated:1991-03-20
Onset:1991-03-27
   Days after vaccination:7
Submitted: 1991-04-12
   Days after onset:15
Entered: 1991-04-29
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285917 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0621F / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Rhinitis, Somnolence, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP, Dimetapp
Current Illness: NONE
Preexisting Conditions: Pyloric stenosis w/pyloromyotomy 5MAR91
Allergies:
Diagnostic Lab Data:
CDC Split Type: OH91041

Write-up: S&S of "runny nose", afternoon naps were longer than usual 5 days prior-5AM check by mom & was breathing, not breathing @ 815AM;


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