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This is VAERS ID 106935

Case Details

VAERS ID: 106935 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Kentucky  
Vaccinated:1998-01-16
Onset:1998-01-17
   Days after vaccination:1
Submitted: 1998-01-23
   Days after onset:6
Entered: 1998-01-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: w/in 24hr SIDS per state;autopsy pending;


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