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This is VAERS ID 159003

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 159003 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Unknown  
Vaccinated:2000-08-04
Onset:2000-08-05
   Days after vaccination:1
Submitted: 2000-08-08
   Days after onset:3
Entered: 2000-08-22
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467674 / - - / IM
HBHEPB: COMVAX / MSD 0293K / - - / IM
IPV: IPV / MERIEUX INST R12512 / - - / -
PNC: PREVNAR / LEDERLE 469692 / - - / IM

Administered by: ?       Purchased by: Unknown
Symptoms: APNEA, CYANOSIS, HEART ARREST, SIDS, STUPOR
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-08-05
   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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC Split Type:

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=159003


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