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This is VAERS ID 155590

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

Case Details

VAERS ID: 155590 (history)  
Form: Version .0  
Age: 0.4  
Sex: Male  
Location: New Hampshire  
Vaccinated:2000-01-03
Onset:2000-02-15
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Pulmonary congestion, Sudden infant death syndrome
SMQs:, Cardiac failure (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-02-15
   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:
Preexisting Conditions: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=155590


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