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This is VAERS ID 150874

Case Details

VAERS ID: 150874 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Texas  
Vaccinated:2000-04-06
Onset:2000-04-06
   Days after vaccination:0
Submitted: 2000-04-07
   Days after onset:1
Entered: 2000-04-10
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-07
   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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC Split Type:

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


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