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This is VAERS ID 160417

Case Details

VAERS ID: 160417 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Kentucky  
Vaccinated:2000-09-22
Onset:2000-09-24
   Days after vaccination:2
Submitted: 2000-10-03
   Days after onset:9
Entered: 2000-10-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public       Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-24
   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: NONE
CDC Split Type: KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


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