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This is VAERS ID 31415

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 31415 (history)  
Form: Version 1.0  
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: 1991-06-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / UNK - / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1726S / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective, Infection, Meningitis
SMQs:, Lack of efficacy/effect (narrow), Noninfectious meningitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
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: WAES91060089

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.


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