VAERS ID: |
76687 (history) |
Form: |
Version .0 |
Age: |
1.4 |
Sex: |
Male |
Location: |
Minnesota |
Vaccinated: | 1991-07-24 |
Onset: | 1991-08-01 |
Days after vaccination: | 8 |
Submitted: |
0000-00-00 |
Entered: |
1994-09-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / - |
- / - |
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / - |
- / - |
Administered by: Private Purchased by: Unknown Symptoms: Pharyngitis,
Pyrexia,
Rash SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 1993-08-03
Days after onset: 733
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: prematurity ( 27 wks gestation,1220 grams birth wt); hypertonia (cerebral palsy); devel delay; none Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: fever, rash , red throat; |