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This is VAERS ID 181512

Case Details

VAERS ID: 181512 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Indiana  
Vaccinated:2002-01-17
Onset:2002-01-19
   Days after vaccination:2
Submitted: 2002-02-11
   Days after onset:23
Entered: 2002-02-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR 3274C / 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR U03442 / 3 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 488175 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 1 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Coma, Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2002-01-19
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-pending Autopsy states; few petechiae of heart, thymus and lungs; early stage of decompression; no evidence of injuries; cultures are neg for pathologic organisms; blood neg for volatiles, acetaminophen and CO; blood salicylate 11.2ug/ml; urine neg for drugs
CDC Split Type:

Write-up: Informed by mom on 2/8/02 that her child was found dead in bed on 1/19/02 about 33 hours after well child visit and immunizations. No previous by us, last immunizations at 6 months. Mom reports an autopsy is being done. Per coroner''s office no autopsy was done in this county. COD as per autopsy report is undetermined. Info rec''d 4/18/02 states; The decedent was an 18 month old white male who lived with his parents. He was pronounced nonviable by medics at 08:55 upon their arrival at the residence. The child was found by his father around 08:45 to be unresponsive and 911 was called. The child was last seen alive by his mother about 23:00 of the night before when she placed him in bed after returning from a birthday party. The child has a clinic visit on 1/17 when he had 5 immunization shots and treatment for dry skin rash. There was bottles of children liquid cold medicine scattered in the kitchen but according to the mother, the infant had not had any since the last time he was sick, about 2 1/2 weeks ago. COD: undetermined.


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