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This is VAERS ID 151749

Case Details

VAERS ID: 151749 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2000-04-04
Onset:2000-04-13
   Days after vaccination:9
Submitted: 2000-04-19
   Days after onset:6
Entered: 2000-05-09
   Days after submission:20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 466024 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1192J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P1232 / 1 - / 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: 2000-04-14
   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: Feeding problems first 3 days of life only.
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SIDS 10 days post vax.


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