| VAERS ID: |
50678 (history) |
| Form: |
Version 1.0 |
| Age: |
1.3 |
| Sex: |
Male |
| Location: |
Oklahoma |
| Vaccinated: | 1993-02-11 |
| Onset: | 1993-02-18 |
| Days after vaccination: | 7 |
| Submitted: |
1993-03-04 |
| Days after onset: | 14 |
| Entered: |
1993-03-11 |
| Days after submission: | 7 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES |
2E41060 / 4 |
LL / IM |
| HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M150JA / 4 |
RL / IM |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0804V / 1 |
LA / SC |
| OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0665F / 3 |
MO / PO |
Administered by: Public Purchased by: Public
Symptoms: Dehydration,
Diarrhoea,
Dyspnoea,
Hepatic steatosis,
Pulmonary oedema,
Pyrexia,
Red blood cell abnormality,
Vomiting
SMQs:, Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1993-02-18
Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: rash & URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type: OK936
Write-up: collapsed on 18FEB93-no prior sx; |
