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This is VAERS ID 269910

Case Details

VAERS ID: 269910 (history)  
Form: Version 1.0  
Age: 1.19  
Sex: Male  
Location: California  
Vaccinated:2006-12-01
Onset:2006-12-12
   Days after vaccination:11
Submitted: 2006-12-22
   Days after onset:10
Entered: 2007-01-02
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Coma
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2006-12-12
   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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


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