National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 162631

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

Case Details

VAERS ID: 162631 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:2000-11-14
Onset:2000-11-15
   Days after vaccination:1
Submitted: 2000-11-20
   Days after onset:5
Entered: 2000-11-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTAP96042 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 473007 / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD R0691 / 0 RL / IM
PNC: PREVNAR / LEDERLE 473337 / 0 RL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: SIDS
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-11-15
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC Split Type:

Write-up: The pt died from SIDS within 24 hours post vax.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=162631


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