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This is VAERS ID 129134

Case Details

VAERS ID: 129134 (history)  
Form: Version 1.0  
Age: 1.2  
Sex: Male  
Location: Virginia  
Vaccinated:1999-09-09
Onset:1999-09-29
   Days after vaccination:20
Submitted: 1999-10-04
   Days after onset:5
Entered: 1999-10-08
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A909A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 423203A / 4 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0699 / 3 RA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0540J / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0308J / 1 LL / SC

Administered by: Private       Purchased by: Private
Symptoms: Bronchitis, Cough, Infection, Lymphadenopathy, Myocarditis, Pharyngitis, Pneumonia, Sepsis, Splenomegaly, Unevaluable event
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (broad), Oropharyngeal infections (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Sepsis (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 1999-09-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Infant vial albuterol via nebulizer
Current Illness: NONE
Preexisting Conditions: mild broncho spasm w/URI, passive tobacco smoke exposure;
Allergies:
Diagnostic Lab Data: autopsy done-final report pending;
CDC Split Type:

Write-up: child well until 1130PM 9/28/99;URI, cough, given neb;awoke well @ 230AM;found dead @ 530AM;autopsy done;lymphadenopathy;slides pending ;dx viremia on preliminary report;


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