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This is VAERS ID 150475

Case Details

VAERS ID: 150475 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Illinois  
Vaccinated:2000-03-15
Onset:2000-03-17
   Days after vaccination:2
Submitted: 2000-03-29
   Days after onset:12
Entered: 2000-03-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-18
   Days after onset: 1
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC Split Type:

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


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