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This is VAERS ID 112005

Case Details

VAERS ID: 112005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Arkansas  
Vaccinated:1998-05-13
Onset:1998-05-31
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 1998-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2368A2 / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0216H / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0031 / 1 RL / SC

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-05-31
   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:
Allergies:
Diagnostic Lab Data: autopsy was done;
CDC Split Type: AR9836

Write-up: pt was red 1130Pm placed on abd on waterbed;pt was discovered by grandfather when pt had not awaken by 8AM; taken to hosp pronounced dead by MD;


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