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This is VAERS ID 154522

Case Details

VAERS ID: 154522 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:2000-05-10
Onset:2000-05-13
   Days after vaccination:3
Submitted: 2000-06-08
   Days after onset:26
Entered: 2000-06-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-13
   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:
Current Illness:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


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