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This is VAERS ID 152213

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 152213 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Arkansas  
Vaccinated:2000-03-30
Onset:2000-03-31
   Days after vaccination:1
Submitted: 2000-03-31
   Days after onset:0
Entered: 2000-05-22
   Days after submission:51
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 0 LL / SC

Administered by: Public       Purchased by: Other
Symptoms: Agitation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-03-31
   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: Autopsy report pending
CDC Split Type: AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=152213


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