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This is VAERS ID 151620

Case Details

VAERS ID: 151620 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Louisiana  
Vaccinated:2000-04-17
Onset:2000-04-17
   Days after vaccination:0
Submitted: 2000-04-26
   Days after onset:9
Entered: 2000-05-05
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-17
   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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


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