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This is VAERS ID 151621

(NOTE: This result is from the 6/11/2011 version of the VAERS database)

Case Details

VAERS ID: 151621 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Connecticut  
Vaccinated:2000-05-02
Onset:2000-05-03
   Days after vaccination:1
Submitted: 2000-05-03
   Days after onset:0
Entered: 2000-05-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 56092A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 0 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cardiac arrest, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-03
   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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20110611&IDNUMBER=151621


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