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From the 12/31/2003 release of VAERS data (an older release, current is 1/7/2022):

This is VAERS ID 159963

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Case Details

VAERS ID: 159963 (history)  
Form: Version .0  
Age: 0.8  
Sex: Female  
Location: Massachusetts  
Vaccinated:2000-09-13
Onset:2000-09-20
   Days after vaccination:7
Submitted: 2000-09-20
   Days after onset:0
Entered: 2000-09-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB / MSD 0429K / 2 LL / IM
PNC: PREVNAR / LEDERLE 473334 / 0 RL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: APNEA, HEART ARREST
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-09-20
   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
Current Illness:
Preexisting Conditions: Initial low blood sugar
Allergies:
Diagnostic Lab Data: Autopsy pending; blood cultures-neg
CDC Split Type:

Write-up: The pt was found pulseless and apneic in crib at 08:00 on 9/20/00.


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