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This is VAERS ID 158472

Case Details

VAERS ID: 158472 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Foreign  
Vaccinated:2000-07-04
Onset:2000-07-05
   Days after vaccination:1
Submitted: 2000-08-01
   Days after onset:27
Entered: 2000-08-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER R10783 / 2 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 121011A / 2 - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Bacterial infection, Malaise, Sepsis
SMQs:, Sepsis (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obesity, metabolic disorder
Allergies:
Diagnostic Lab Data: Autopsy revealed cause of death as pneumococcal sepsis.
CDC Split Type: WAES00072420

Write-up: This 11-year-old male received vaxs and one day post vax, became "severely ill (not specified) and was admitted to the hospital. Reanimation was unsuccessful and the pt died. An autopsy was performed that revealed a pneumococcal sepsis," which was the cause of death. Severe malaise was also considered life threatening event.


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