VAERS ID: |
73024 (history) |
Form: |
Version 1.0 |
Age: |
1.0 |
Sex: |
Male |
Location: |
Mississippi |
Vaccinated: | 1995-03-17 |
Onset: | 1995-03-24 |
Days after vaccination: | 7 |
Submitted: |
1995-03-28 |
Days after onset: | 4 |
Entered: |
1995-04-07 |
Days after submission: | 9 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
TR1225ASB / 4 |
RL / IM |
HIBV: HIB (HIBTITER) / PFIZER/WYETH |
M305LF / 4 |
LL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0885A / 1 |
RA / SC |
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH |
0715H / 3 |
MO / PO |
Administered by: Public Purchased by: Public Symptoms: Gastroenteritis,
Infection,
Lung disorder,
Pneumonia SMQs:, Eosinophilic pneumonia (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1995-03-24
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: asthma meds;(name unk) Current Illness: cold Preexisting Conditions: asthma Allergies:
Diagnostic Lab Data: CDC Split Type: MS95013
Write-up: pt recvd vax;pt died;autopsy performed;rpt indicated that pin point lesions were found on the large intestines,there was no stool(s) in the large intestines;?viral gastroenteritis,lungs were hard & firm, ?viral pneumonia,liver soft & firm; |