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This is VAERS ID 151190

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 151190 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:2000-04-06
Onset:2000-04-09
   Days after vaccination:3
Submitted: 2000-04-18
   Days after onset:9
Entered: 2000-05-04
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTAP9121A2 / 1 RL / IM
HBHEPB: COMVAX / MSD 1980J / 1 LL / IM
IPV: IPV / MERIEUX INST R0444 / 1 LL / -

Administered by: Private       Purchased by: Unknown
Symptoms: SIDS
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-04-09
   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:
CDC Split Type:

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was"not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed


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