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This is VAERS ID 150931

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 150931 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-03-31
Onset:2000-04-01
   Days after vaccination:1
Submitted: 2000-04-04
   Days after onset:2
Entered: 2000-04-13
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 40040CA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy
CDC Split Type:

Write-up: Pt was well and went to sleep at approximately 10:30 pm. Found at 6:00 am not breathing. Pt had been put to sleep on her side but was found on stomach.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180814&IDNUMBER=150931


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