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This is VAERS ID 110238

Case Details

VAERS ID: 110238 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Tennessee  
Vaccinated:1998-04-20
Onset:1998-04-21
   Days after vaccination:1
Submitted: 1998-04-21
   Days after onset:0
Entered: 1998-04-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / 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: 1998-04-21
   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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


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