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This is VAERS ID 150074

Case Details

VAERS ID: 150074 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Virginia  
Vaccinated:2000-03-11
Onset:2000-03-12
   Days after vaccination:1
Submitted: 2000-03-13
   Days after onset:1
Entered: 2000-03-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC Split Type: U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


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