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This is VAERS ID 108796

Case Details

VAERS ID: 108796 (history)  
Form: Version 1.0  
Age:   
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-01-02
Onset:1997-01-20
   Days after vaccination:18
Submitted: 1998-03-19
   Days after onset:423
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0165D / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Cyanosis, Eosinophilia, Jaundice, Sudden infant death syndrome, Unevaluable event
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: newborn
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9731

Write-up: SIDS;newborn jaundice tx w/phototherapy @ home;


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