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This is VAERS ID 459278

Case Details

VAERS ID: 459278 (history)  
Form: Version 1.0  
Age: 0.27  
Sex: Male  
Location: Illinois  
Vaccinated:1990-05-07
Onset:0000-00-00
Submitted: 2012-07-14
Entered: 2012-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / IM

Administered by: Private       Purchased by: Other
Symptoms: Death, Pulse absent, Pyrexia, Respiratory arrest, Respiratory tract congestion, Resuscitation, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-05-08
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Infant Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 05/07/1990 patient went to the Doctor and had a physical, which the doctor said he was in good health and doing well for his age and he also received 2 vaccinations MMR and DPT. He was congested and had a fever after receiving his shots. I gave him infant Tylenol during the day and before I put him to sleep. At 7am approximately 12 hours later I found patient in his bed not breathing and without a pulse. I performed CPR but patient died. The coroner determined that the cause of death was SIDS.


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