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This is VAERS ID 158477

Case Details

VAERS ID: 158477 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Mexico  
Vaccinated:2000-07-31
Onset:2000-08-01
   Days after vaccination:1
Submitted: 2000-08-04
   Days after onset:3
Entered: 2000-08-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0290K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Coma, Conjunctivitis, Nasal congestion, Pulmonary congestion, Seborrhoeic dermatitis, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conjunctival disorders (narrow), Ocular infections (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-08-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death from SIDS. Autopsy shows congestion of thymus, lungs, adrenals and spleen. Also shows seborrhic dermatitis, conjunctivitis, unresponsive.


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