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This is VAERS ID 150974

Case Details

VAERS ID: 150974 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: Washington  
Vaccinated:2000-03-29
Onset:2000-04-02
   Days after vaccination:4
Submitted: 2000-04-05
   Days after onset:2
Entered: 2000-04-17
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private       Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-02
   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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


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