VAERS ID: |
233373 (history) |
Form: |
Version 1.0 |
Age: |
1.01 |
Sex: |
Male |
Location: |
Georgia |
Vaccinated: | 2005-02-01 |
Onset: | 2005-02-03 |
Days after vaccination: | 2 |
Submitted: |
2005-02-03 |
Days after onset: | 0 |
Entered: |
2005-02-03 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
41580AA / 2 |
RL / IM |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0608P / 1 |
RA / SC |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
0765P / 1 |
LA / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Apnoea,
Hypothermia,
Sudden infant death syndrome SMQs:, Acute central respiratory depression (narrow), Accidents and injuries (broad), Neonatal disorders (narrow), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2005-02-03
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: Upper respiratory infection Preexisting Conditions: None Allergies: Diagnostic Lab Data: Autopsy is pending CDC Split Type:
Write-up: Patient was found this afternoon cold and not breathing. His resuscitation was not successful. Autopsy report received stated COD was SIDS. |