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This is VAERS ID 162631

(NOTE: This result is from the 2/14/2018 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=20180214&IDNUMBER=162631


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