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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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