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This is VAERS ID 107790

Case Details

VAERS ID: 107790 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Arizona  
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted: 1998-02-16
Entered: 1998-02-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt expired presumed SIDS 56hr p/vax;


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