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This is VAERS ID 152417

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 152417 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:2000-05-22
Onset:2000-05-25
   Days after vaccination:3
Submitted: 2000-05-25
   Days after onset:0
Entered: 2000-05-30
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7389AA / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 530453A / 0 RL / IM
IPV: IPV / MERIEUX INST P13812 / 0 - / SC

Administered by: Private       Purchased by: Unknown
Symptoms: EDEMA LUNG, LUNG DIS, SIDS
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-05-25
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=152417


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