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This is VAERS ID 109562

Case Details

VAERS ID: 109562 (history)  
Form: Version 1.0  
Age: 0.58  
Sex: Male  
Location: Unknown  
Vaccinated:1998-02-19
Onset:1998-02-20
   Days after vaccination:1
Submitted: 1998-03-30
   Days after onset:38
Entered: 1998-04-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-20
   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~ ()~~0.00~Patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


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