National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 592715

Case Details

VAERS ID: 592715 (history)  
Form: Version 1.0  
Age: 1.75  
Sex: Female  
Location: Alabama  
Vaccinated:2015-08-31
Onset:2015-09-01
   Days after vaccination:1
Submitted: 2015-09-03
   Days after onset:2
Entered: 2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 3 RL / UN

Administered by: Private       Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Drug screen negative, Life support, Retching, Urine ketone body present, pH urine normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2015-09-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC Split Type:

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=592715


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166