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This is VAERS ID 107771

Case Details

VAERS ID: 107771 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: New York  
Vaccinated:1997-10-31
Onset:1997-11-01
   Days after vaccination:1
Submitted: 1998-02-13
   Days after onset:104
Entered: 1998-02-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 444250 / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 7100A / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Insomnia, Pyrexia, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-11-01
   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: NONE
Current Illness: sl cough
Preexisting Conditions: reactive ariway disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, crankiness, sleepless;


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