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This is VAERS ID 109219

Case Details

VAERS ID: 109219 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Tennessee  
Vaccinated:1998-01-28
Onset:1998-01-29
   Days after vaccination:1
Submitted: 1998-01-30
   Days after onset:1
Entered: 1998-04-03
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-01-29
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


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