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This is VAERS ID 111281

Case Details

VAERS ID: 111281 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Oregon  
Vaccinated:1998-02-17
Onset:1998-02-26
   Days after vaccination:9
Submitted: 1998-03-18
   Days after onset:20
Entered: 1998-06-01
   Days after submission:74
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 444071 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RJ / 3 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443 / 3 LL / 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: 1998-02-26
   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: fluoride drops
Current Illness: nasal congestion only
Preexisting Conditions: diastasis recti, yeast diaper rash
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: OR9803

Write-up: no adverse effects noted in period immed p/vax;pt died SIDS death 26FEB98 @ home;


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