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This is VAERS ID 109867

Case Details

VAERS ID: 109867 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Iowa  
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted: 1998-04-16
Entered: 1998-04-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

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: 1998-04-15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC Split Type: IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


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