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This is VAERS ID 150474

Case Details

VAERS ID: 150474 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Montana  
Vaccinated:2000-03-16
Onset:2000-03-17
   Days after vaccination:1
Submitted: 2000-03-21
   Days after onset:4
Entered: 2000-03-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-17
   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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC Split Type:

Write-up: Accidental suffocation 24 hours post vax.


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