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This is VAERS ID 161415

Case Details

VAERS ID: 161415 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:2000-08-22
Onset:2000-09-27
   Days after vaccination:36
Submitted: 2000-10-07
   Days after onset:10
Entered: 2000-11-07
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

Administered by: Private       Purchased by: Other
Symptoms: Meningitis, Pneumonia
SMQs:, Noninfectious meningitis (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC Split Type: OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


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