This is VAERS ID 162631

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID:	162631 (history)
Form:	Version 1.0
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: DTAP (INFANRIX) / SMITHKLINE BEECHAM	96042 / 1	LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH	473007 / 1	LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD.	R0691 / 1	RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH	473337 / 1	RL / IM

Administered by: Private Purchased by: Other
Symptoms: Sudden infant death syndrome
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.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=162631