National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 31415

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

Case Details

VAERS ID: 31415 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: Alaska  
Vaccinated:1991-02-28
Onset:1991-03-28
   Days after vaccination:28
Submitted: 1991-06-13
   Days after onset:76
Entered: 1991-06-21
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: UNK. DTP / UNCLASSIFIED - / - - / -
HEP: RECOMBIVAX HB / MSD - / - - / -
HIBV: PEDVAXHIB / MSD 1726S / 0 - / -

Administered by: Other       Purchased by: Unknown
Symptoms: INFECT, MENINGITIS, NO DRUG EFFECT
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-05-26
   Days after onset: 58
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OPV vax given 2Mar91
Current Illness:
Preexisting Conditions: alaskan infant, 25 wks gestation & had bronchopulmonary dysplasia
Allergies:
Diagnostic Lab Data: A CSF & blood culture confirmed the DX of haemophilus influenzae,type of infect.28Mar91 Blood culture-Haemop Influ type B;28Mar91 CSF-haemop Influ type B
CDC Split Type:

Write-up: Pt vax w/HIBV/HEP/DTP/on 28FEB91. Vax w/ OPV 2MAR91. Pt hospitalized on 28MAR91 w/meningitis. Recovered w/o sequelae & D/C on 9APR91.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=31415


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166