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This is VAERS ID 161215

Case Details

VAERS ID: 161215 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Male  
Location: Indiana  
Vaccinated:2000-07-24
Onset:2000-07-25
   Days after vaccination:1
Submitted: 2000-10-27
   Days after onset:94
Entered: 2000-11-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea
SMQs:, Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-07-25
   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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


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