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This is VAERS ID 111282

Case Details

VAERS ID: 111282 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alabama  
Vaccinated:1998-05-14
Onset:1998-05-19
   Days after vaccination:5
Submitted: 1998-05-20
   Days after onset:1
Entered: 1998-06-01
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 847A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1226E / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7E91927 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0843 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: AL984

Write-up: death-19MAY98;coroner says SIDS-unable to obtain death certificate d/t state privacy laws


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