National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 161164

Case Details

VAERS ID: 161164 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Minnesota  
Vaccinated:2000-09-22
Onset:2000-09-26
   Days after vaccination:4
Submitted: 2000-10-18
   Days after onset:22
Entered: 2000-11-01
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-26
   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: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161164


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166