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This is VAERS ID 162102

Case Details

VAERS ID: 162102 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Florida  
Vaccinated:2000-11-07
Onset:2000-11-07
   Days after vaccination:0
Submitted: 2000-11-15
   Days after onset:8
Entered: 2000-11-17
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3222A2 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-09
   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: NONE
Current Illness: NONE
Preexisting Conditions: Trisomy 21, questionable history of holes in heart.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt was seen 11/07 for 2 month physical evaluation and received Hepatitis B vax. No problems occurred while in the office. He apparently developed respiratory problems on the car ride home and was transferred to the hospital ER and then to another hospital by ambulance. He expired on 11/09/2000.


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