This is VAERS ID 233373

Case Details

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.

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