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This is VAERS ID 71851

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 71851 (history)  
Form: Version .0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:1995-01-25
Onset:1995-01-27
   Days after vaccination:2
Submitted: 1995-01-30
   Days after onset:3
Entered: 1995-03-01
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51056 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4K51059 / - - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0683A / 0 - / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0708M / 2 - / PO

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1995-01-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: PAR denied any illnesses
Preexisting Conditions: NKA per PAR;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CA95027

Write-up: pt recvd vax 3rd dose of OPV, 3rd dose DTP/HIB & 1st dose of MMR on 25jan95; pt died at home 27jan95;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=71851


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