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This is VAERS ID 156329

Case Details

VAERS ID: 156329 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:2000-05-31
Onset:2000-06-01
   Days after vaccination:1
Submitted: 2000-06-30
   Days after onset:29
Entered: 2000-07-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0056FA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0053K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0997 / 1 RL / IM

Administered by: Public       Purchased by: Other
Symptoms: Apnoea, Coma, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Salivary hypersecretion, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-01
   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: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autopsy-pending (SIDS)
CDC Split Type: MS00026

Write-up: Post vax, on 6/1/2000 AM, the mother stated that infant was fine when he was put in bed with her and then when she tried to awaken the child, he was lying on his stomach with mucus from mouth and not breathing. Autopsy shows cause of death as sudden infant death, pulmonary congestion and edema, splenic congestion, renal congestion, unresponsive.


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