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This is VAERS ID 112660

Case Details

VAERS ID: 112660 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Washington  
Vaccinated:1998-06-01
Onset:1998-06-04
   Days after vaccination:3
Submitted: 1998-07-13
   Days after onset:39
Entered: 1998-07-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 7G81489 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7L91652 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1070 / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Gastroenteritis, Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow), Noninfectious diarrhoea (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-20
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy was done & findings to explain death;probably SIDS;
CDC Split Type:

Write-up: pt recv vax 1JUN98 & pt had gastroenteritis on 4JUN98 which resolved;gastroenteritis reoccurred on 19JUN98;pt died of SIDS on 20JUN98;


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