National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/14/2022 release of VAERS data:

This is VAERS ID 206350

Government Disclaimer on use of this data



Case Details

VAERS ID: 206350 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Washington  
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted: 2003-06-23
Entered: 2003-07-18
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2003-06-20
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:
CDC Split Type: WA031950

Write-up: Coroner ruled SIDS.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=206350


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166