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This is VAERS ID 152502

Case Details

VAERS ID: 152502 (history)  
Form: Version 1.0  
Age: 0.08  
Sex: Male  
Location: Alabama  
Vaccinated:1999-12-06
Onset:1999-12-07
   Days after vaccination:1
Submitted: 1999-12-10
   Days after onset:3
Entered: 2000-05-30
   Days after submission:171
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-12-07
   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: NONE
Current Illness: NONE
Preexisting Conditions: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC Split Type:

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


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