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This is VAERS ID 152001

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 152001 (history)  
Form: Version .0  
Age: 0.2  
Sex: Female  
Location: Maine  
Vaccinated:2000-04-13
Onset:2000-04-18
   Days after vaccination:5
Submitted: 2000-05-10
   Days after onset:22
Entered: 2000-05-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 0 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 0 LL / SC

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: 2000-04-18
   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: Postmortem exam.
CDC Split Type:

Write-up: Two month old died of SIDS 5 days post vax (1st set).


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=152001


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