Age: 0.17
Sex: M
Vaccine: DTAP, HEP, IPV, UNK
Symptoms: Laboratory test abnormal, Premature baby
Clinical narrative: This subject is a two month, 21 day old male, who was pronounced dead on Feb 22, 2003 due to complications of prematurity while enrolled in a Daptecel  study. The subject did not receive any doses of study vaccine, howvere, they did receive other pediatric vaccines: IPV, HbOC, Hep B, Infanrix, and Prevnar. The last doses to the event were given on Feb 06, 2003. The subject developed complications due to prematurity priori to receiving any vaccinations. The subject was pronounced dead at medical center. The event of complications due to prematurity was reported by the investigator as unrelated to the study vaccine. Case closed. Cause of death- complications of prematurity. The radiographic findings are abnormal and indicative of diffuse metabolic bone disease, specifically rickets. The type of periosteal reaction seen in this case is common in sick premature infants and resukts from the stress induced by routine handling (such as diaper changing) placed on weakened bones. There is no sutopsy or radiographic evidence of abusive trauma. Subject has several complications of prematurity. The most significant is anemia, reflected by the diffuse visceral pallor, reactive bone marrow, and extreme EMP with splenomegaly. The etiology of the anemia is not entirely clear. Initially the anemia fit the picture seen in premature infants. however, there appears to have been a significant drop in hematocrit over a 12 hour period (25.5 % to 17.2%, with the second value taken one hour after resuscitative efforts started). The initial CBC showed fragmented RBC's suggestive of intravascular hemolysis, however, bilirubin studies were not  done. The differential diagnosis for hemolytic anemias includes congenital and acquired etiologies. The subject was treated for a fungal infection during his initial hospitalization at UCD. DIC from recurrent fungal sepsis is a possible cause for the rapid anemia. His laboratory studies on the day of death clinically reflect DIC (low platelet count, elevated PT and PTT, and decreased fibrinogen): however his sever liver disease could also explain the latter three indices. The elevated WBC with left shift is supportive of sepsis: however, this could also reflect the market EMH in the spleen, which lacks the control ofthe bone marrow in releasing blood elements into circulation. Rectal temp was recorded as 89.1 degrees F at 0733 (methodist). External examination: Body is that of a well developed over hydrated, well nourished 17", 7lbs, light brown pigmented, male infant, whose appearance is smaller than the rpeorted age of 2 months and 21 days. Weight is 2940grm. Head circumference 34.2cm. Chest circumference 32.4cm. Abdominal circumference 34.0cm. Crown-rump length 33.2cm. Crown heel length 47.0cm. The head is edematous with marked periobital edema. The eyes have cloudy corneas and dark irides. The lips and oral mucosa are pale, moist and without trauma, there is marked scrotal edema precluding evaluation of the testes. The umbilicus is distended, but there is no heriantion. External evidence of injury: there is marked edema of the scalp. The anterior fontanel measures 3.0cm. The sutures are mobile, but not widened or overlapping. Lungs (x5)- dissuse atelectasis: focal hyaline membranes in one section from the right lung, increased number of alveolar macrophages; no acute or interstitial inflammation. Liver: architecture distroted by portal fibrosis with bile ductule proliferation, lobular disarray with hepatocyte degeneration, and cholestasis, and microvesicular steatosi: patchy moderate extramedullary hematopoesis. Kidney; patchy extramedullary hematopoesis. Splee: total effacement of architecture by ,arked extramedullary hematopoesis consisting of mixed lineage cells similar to what is seen in the bone marrow. Fungal stain is negative. The brain is small with a mature gyral an 0.8 cm opercula over insukar lobes. The brain is not swollen. There is no sign of herniation or of cerebral midline shift. The leptomeninges are thin, delicate, and transparent. Note: There is no gross or histologic evidence of resolving germinal matrix hemorrhage or periventricular leukomalacia. Follow up on 04/21/04: "After a medical review of the case, a new version of the report has been generated to add the adverse event term "condition aggravated", and to add the interval between the date of immunization and the fatal outcome due to aggravation of the prematurity condition, 16 days."