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This is VAERS ID 151618

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 151618 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2000-05-02
Onset:2000-05-04
   Days after vaccination:2
Submitted: 2000-05-04
   Days after onset:0
Entered: 2000-05-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-04
   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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=151618


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