National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 111280

Case Details

VAERS ID: 111280 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1998-03-24
Onset:1998-04-01
   Days after vaccination:8
Submitted: 1998-04-02
   Days after onset:1
Entered: 1998-06-01
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2405A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305PN / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Stupor, Sudden infant death syndrome, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-04-01
   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: unk
Current Illness: NONE
Preexisting Conditions: discharged from hosp for RSV 13MAR98;
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: OR9805

Write-up: pt mom reported finding pt unresponsive @ 10AM on 1APR98;911 was dispatched;pt was pronounced SIDS by medical examiner @ home;


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=111280


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166