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This is VAERS ID 25683

Case Details

VAERS ID: 25683 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Missouri  
Vaccinated:1990-06-29
Onset:1990-07-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 1990-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271911 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0603F / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-07-02
   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:
Preexisting Conditions: hx of infantile apnea syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV found dead 4 days after receiving vac. Infant apnea syndrome on monitor.


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