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This is VAERS ID 161811

Case Details

VAERS ID: 161811 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Louisiana  
Vaccinated:2000-09-08
Onset:2000-09-16
   Days after vaccination:8
Submitted: 2000-11-06
   Days after onset:51
Entered: 2000-11-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0289K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Cardiac disorder, Nasal congestion, Pulmonary oedema, Sudden infant death syndrome, Upper respiratory tract infection
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-16
   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: Autopsy; blood cultures-all results neg-SIDS
CDC Split Type:

Write-up: Post vax, the pt developed URI symptoms. Was seen in office on 9/14/00 with nasal congestion. She had a cardiac event on 9/16/00 and died. Autopsy revealed SIDS. Autopsy shows pulmonary edema.


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