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This is VAERS ID 151748

Case Details

VAERS ID: 151748 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2000-03-22
Onset:2000-04-17
   Days after vaccination:26
Submitted: 2000-04-20
   Days after onset:3
Entered: 2000-05-09
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 14775 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P09052 / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (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: hydrocortisone for dermatitis 3/22/2000
Current Illness: NONE
Preexisting Conditions: Possible milk protein allergy, dermatitis.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS death within one months of IZ. Autopsy being performed.


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