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This is VAERS ID 113404

Case Details

VAERS ID: 113404 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1998-08-07
Onset:1998-08-08
   Days after vaccination:1
Submitted: 1998-08-09
   Days after onset:1
Entered: 1998-08-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2425A2 / 2 LL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-08
   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: UNK
Current Illness: NONE
Preexisting Conditions: Pt mother hx of substance abuse through pregnancy.
Allergies:
Diagnostic Lab Data: AUTOPSY PENDING
CDC Split Type:

Write-up: Pt recv vax on 8/7/98. Pt presented DOA, presumably SIDS on 8/8/98.


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