VAERS ID: |
158751 (history) |
Form: |
Version .0 |
Age: |
0.8 |
Sex: |
Male |
Location: |
Wisconsin |
Vaccinated: | 2000-07-27 |
Onset: | 2000-07-28 |
Days after vaccination: | 1 |
Submitted: |
2000-07-31 |
Days after onset: | 3 |
Entered: |
2000-08-14 |
Days after submission: | 14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES |
475228 / 1 |
LL / IM |
Administered by: Private Purchased by: Private Symptoms: Cardio-respiratory arrest,
Unevaluable event SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2000-07-28
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: Sinusitis Preexisting Conditions: Walker-Warburg syndrome Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest. . |