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This is VAERS ID 151867

Case Details

VAERS ID: 151867 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Georgia  
Vaccinated:2000-05-10
Onset:2000-05-11
   Days after vaccination:1
Submitted: 2000-05-11
   Days after onset:0
Entered: 2000-05-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


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