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This is VAERS ID 108797

Case Details

VAERS ID: 108797 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-10-16
Onset:1997-11-10
   Days after vaccination:25
Submitted: 1998-03-19
   Days after onset:129
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-19
   Days after onset: 129
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


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