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This is VAERS ID 580878

Case Details

VAERS ID: 580878 (history)  
Form: Version 1.0  
Age: 0.24  
Sex: Female  
Location: California  
Vaccinated:1990-05-19
Onset:1990-05-19
   Days after vaccination:0
Submitted: 2015-06-08
   Days after onset:9151
Entered: 2015-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHEP: DTP + HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / -
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 UN / -

Administered by: Private       Purchased by: Other
Symptoms: Cold sweat, Crying, Death, Decreased appetite, Laboratory test, Lethargy, Pallor
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-05-21
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient was on nothing else...
Current Illness: Patient had been mildly ill about a month prior to her vaccinations. She was healthy for several weeks prior to vaccination.
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Too dang many to list you are welcome to get her records
CDC Split Type:

Write-up: My daughter got her vaccines and within hours was lethargic, no appetite, clammy to the touch, whimpering and pale.


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