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This is VAERS ID 181512

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 181512
VAERS Form:
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / AVENTIS PASTEUR, 3274C / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR, U03442 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 0 RA / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATO 488175 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 0 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 11.2
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 chi


Changed on 12/8/2009

VAERS ID: 181512 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / AVENTIS PASTEUR, AVENTIS PASTEUR 3274C / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR, AVENTIS PASTEUR U03442 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 0 RA / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATO LEDERLE LABORATORIES 488175 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 0 LA / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Coma, Petechiae, STUPOR, PETECHIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 11.2
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 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 chi 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.


Changed on 3/2/2010

VAERS ID: 181512 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / AVENTIS PASTEUR 3274C / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR U03442 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 0 RA / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 488175 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 0 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Coma, Petechiae

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 11.2
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.


Changed on 4/7/2010

VAERS ID: 181512 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / AVENTIS PASTEUR 3274C / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR U03442 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 0 RA / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 488175 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 0 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Coma, Petechiae

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 11.2
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.


Changed on 5/14/2017

VAERS ID: 181512 Before After
VAERS Form:
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / AVENTIS PASTEUR SANOFI PASTEUR 3274C / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR SANOFI PASTEUR U03442 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 0 RA / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 488175 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 0 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Coma, Petechiae

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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 11.2 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.


Changed on 9/14/2017

VAERS ID: 181512 Before After
VAERS Form:(blank) 1
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPH: DTAP + HIB (TRIHIBIT) / SANOFI PASTEUR 3274C / 3 4 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR U03442 / 2 3 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1094L / 0 1 RA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 488175 / 1 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1235L / 0 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Coma, Petechiae

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 181512 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 181512 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 181512 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 181512 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 10/14/2018

VAERS ID: 181512 Before After
VAERS Form:1
Age:1.5
Sex:Male
Location:Indiana
Vaccinated:2002-01-17
Onset:2002-01-19
Submitted:2002-02-11
Entered:2002-02-20
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2002-01-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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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