| 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; |
