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This is VAERS ID 68431

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

Case Details

VAERS ID: 68431 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Illinois  
Vaccinated:1994-10-31
Onset:1994-11-01
   Days after vaccination:1
Submitted: 1994-11-04
   Days after onset:3
Entered: 1994-11-14
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51123 / 4 RA / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51123 / UNK RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0403A / 1 LA / -

Administered by: Other       Purchased by: Public
Symptoms: Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-11-01
   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: phenobarbital;
Current Illness: sz dis,poss ?;poor growth;cerebral palsy
Preexisting Conditions: h/o 32 wk premature, twin A: h/o apnea bradycardia, sz disorder; mixed cerebral palsy;
Allergies:
Diagnostic Lab Data: unofficial result of autopsy is pneumonia;
CDC Split Type:

Write-up: pt recvd vax on 31oct94 am; at 11:30am on 1nov94 laughing, playfull & took nap; at 1:15pm found in crib by pub hlth nurse cold & pulseness; to er, t 88.9 rectally; resucitation unsuccessful; pronounced dead at 2pm;


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