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This is VAERS ID 108127

Case Details

VAERS ID: 108127 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: New Jersey  
Vaccinated:1998-02-11
Onset:1998-02-15
   Days after vaccination:4
Submitted: 1998-02-27
   Days after onset:12
Entered: 1998-03-11
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: 1998-02-15
   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: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC Split Type:

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


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