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This is VAERS ID 110675

Case Details

VAERS ID: 110675 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: California  
Vaccinated:1998-03-24
Onset:1998-04-04
   Days after vaccination:11
Submitted: 1998-05-06
   Days after onset:31
Entered: 1998-05-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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: 1998-04-04
   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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC Split Type:

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


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