National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 158751

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 158751 (history)  
Form: Version 1.0  
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) / PFIZER/WYETH 475228 / 2 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), Respiratory failure (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.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180914&IDNUMBER=158751


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166