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This is VAERS ID 35495

Case Details

VAERS ID: 35495 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New York  
Vaccinated:1991-09-25
Onset:1991-09-26
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1991-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1J21062 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M140HF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0627D / 2 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Agitation, Drug ineffective, Meningitis, Pyrexia, Shock, Somnolence
SMQs:, Anaphylactic reaction (narrow), Lack of efficacy/effect (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1991-09-29
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: LP-pneumococcal meningitis;
CDC Split Type:

Write-up: W/in 24 hrs pt irritable, fever, lethargy; Seen 2nd day pt shocky & moribund; had pneumococcal meningitis by LP;


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