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This is VAERS ID 162587

Case Details

VAERS ID: 162587 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Carolina  
Vaccinated:2000-11-09
Onset:2000-11-10
   Days after vaccination:1
Submitted: 2000-11-22
   Days after onset:12
Entered: 2000-11-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-10
   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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC Split Type:

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


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