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This is VAERS ID 30429

Case Details

VAERS ID: 30429 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Mississippi  
Vaccinated:1991-03-12
Onset:1991-03-13
   Days after vaccination:1
Submitted: 1991-04-18
   Days after onset:35
Entered: 1991-05-13
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298915 / 3 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M160FH / 1 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, Apnoea, Bronchitis, Cardiac failure, Cyanosis, Pharyngitis, Pneumonia, Pyrexia
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-14
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: Congenital anormalies many of which are consistent w/those seen in Down''s synd;
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type: MS9117

Write-up: Mom indicated p/immun fussy & irritable running low grade fever, diminished appetite, to ER;PE in ER indicated inflamed posterior pharynx w/o exudate;14MAR91 experienced resp arrest mom called to ER in complete cardiac & Resp arrest;


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