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This is VAERS ID 106657

Case Details

VAERS ID: 106657 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: Tennessee  
Vaccinated:1997-12-08
Onset:1997-12-09
   Days after vaccination:1
Submitted: 1997-12-09
   Days after onset:0
Entered: 1998-01-20
   Days after submission:42
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-12-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


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