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This is VAERS ID 160877

Case Details

VAERS ID: 160877 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:2000-10-05
Onset:2000-10-06
   Days after vaccination:1
Submitted: 2000-10-18
   Days after onset:12
Entered: 2000-10-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Bacterial infection, Coma, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC Split Type:

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


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