VAERS ID: 25534

AGE: 4| SEX: F|STATE: NY (United States)

Description

4 1/2 yr old child 25Jun90/w positive blood culture for h. Influenzae type B. Child received immunization on 9Dec87

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Symptoms

Drug ineffective, Infection

Vaccines

VAX DATE: 12-09-1987| ONSET DATE: 06-25-1990| DAYS TO ONSET: 929
NameDose #TypeManufacturerLotRouteSite
HIB POLYSACCHARIDE (HIBIMUNE) Unknown HBPV PFIZER\WYETH 181666 Unknown Unknown

RECVDATE:07-16-1990
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:06-25-1990
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:9001160.01
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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