VAERS ID: 25520

AGE: 71| SEX: M|STATE: FR

Description

71 yr old male w/presenile dementia, diabetes mellitus, & renal failure received Hepatitis B vaccine, recombinant, 40 mcg, IM. Dialysis shunt became infected Dx w/sepsis therapy initiated w/flucloxacillin, however pt died that day.

Symptoms

Sepsis

Vaccines

VAX DATE: 02-03-1988| ONSET DATE: 02-17-1990| DAYS TO ONSET: 745
NameDose #TypeManufacturerLotRouteSite
HEP B (RECOMBIVAX HB) Unknown HEP MERCK & CO. INC. IM Unknown

RECVDATE:07-13-1990
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:02-17-1990
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:Tolbutamide, Vitamin B, Vitamin C
CUR_ILL:Presenile dementia; Diabetes mellitus
HISTORY:Renal dialysis; Renal failure
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:WAES90060030
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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