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This is VAERS ID 113437

Case Details

VAERS ID: 113437 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1998-06-05
Onset:1998-06-07
   Days after vaccination:2
Submitted: 1998-08-12
   Days after onset:66
Entered: 1998-08-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A840A2 / UNK RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH 7C91702 / UNK LL / -

Administered by: Private       Purchased by: Public
Symptoms: Anorexia, Cyanosis, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-06-07
   Days after onset: 0
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt was seen for immun;pt was okay @ that time;2 days p/had poor feeding; found blue in crib;taken to hosp pt was found dead possible SIDS;


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