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This is VAERS ID 159003

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 159003 (history)  
Form: Version .0  
Age: 0.25  
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: 2000-08-21
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / - - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / - - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / - - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / - - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

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=20170214&IDNUMBER=159003


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