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This is VAERS ID 108794

Case Details

VAERS ID: 108794 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: New Hampshire  
Vaccinated:1997-05-29
Onset:1997-06-07
   Days after vaccination:9
Submitted: 1998-03-19
   Days after onset:285
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-06-07
   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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9733

Write-up: SIDS


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