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This is VAERS ID 162748

Case Details

VAERS ID: 162748 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Michigan  
Vaccinated:2000-09-18
Onset:2000-09-20
   Days after vaccination:2
Submitted: 2000-11-20
   Days after onset:61
Entered: 2000-11-29
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private       Purchased by: Public
Symptoms: Pneumonia, Unevaluable event
SMQs:, 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: 2000-09-20
   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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


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