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This is VAERS ID 26175

Case Details

VAERS ID: 26175 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Washington  
Vaccinated:1990-09-05
Onset:1990-09-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 1990-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 0F11072 / UNK - / -

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: 0000-00-00
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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP 5SEP90 developed SIDS.


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