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This is VAERS ID 113916

Case Details

VAERS ID: 113916 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Alaska  
Vaccinated:1998-07-27
Onset:1998-08-13
   Days after vaccination:17
Submitted: 1998-08-14
   Days after onset:1
Entered: 1998-09-08
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 451498 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0238H / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1177E / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M12952 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: unk~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE (infant-prenatal hx of drug use by mom)
Allergies:
Diagnostic Lab Data: autopsy performed-unk results as to cause of death
CDC Split Type: AK9199811

Write-up: no adverse events reported by grandmo (caregiver) she stated did fine & no problems;


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