This is VAERS ID 158751

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

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. .

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=158751