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This is VAERS ID 108655

Case Details

VAERS ID: 108655 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: North Carolina  
Vaccinated:1998-03-12
Onset:1998-03-13
   Days after vaccination:1
Submitted: 1998-03-16
   Days after onset:3
Entered: 1998-03-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome
SMQs:, Congenital, familial and genetic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Neonatal disorders (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


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