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This is VAERS ID 151190

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

Case Details

VAERS ID: 151190 (history)  
Form: Version 1.0  
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: 2000-05-03
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 2 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
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: OR200012

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 to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


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