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This is VAERS ID 152417

(NOTE: This result is from the 8/14/2018 version of the VAERS database)

Case Details

VAERS ID: 152417 (history)  
Form: Version 1.0  
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: 2000-05-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow), Infective pneumonia (broad)

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=20180814&IDNUMBER=152417


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