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This is VAERS ID 174843

Case Details

VAERS ID: 174843 (history)  
Form: Version 1.0  
Age: 1.4  
Sex: Female  
Location: Colorado  
Vaccinated:2000-10-18
Onset:2000-10-26
   Days after vaccination:8
Submitted: 2001-08-28
   Days after onset:306
Entered: 2001-08-31
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other       Purchased by: Other
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-10-26
   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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


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