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This is VAERS ID 163135

Case Details

VAERS ID: 163135 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Tennessee  
Vaccinated:2000-09-05
Onset:2000-09-06
   Days after vaccination:1
Submitted: 2000-11-05
   Days after onset:60
Entered: 2000-12-06
   Days after submission:31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 941A2 / 3 LA / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3142A2 / 2 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA524AA / 3 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R06913 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0539J / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Asphyxia, Unevaluable event
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-06
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Infant was behind on immunizations. Mother gave a negative history for previous adverse reactions. Infant was put to bed for the evening and expired. Cause of death is undetermined. Autopsy states cause of death as asphyxia.


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