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This is VAERS ID 26196

Case Details

VAERS ID: 26196 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Female  
Location: Michigan  
Vaccinated:1990-08-20
Onset:1990-08-22
   Days after vaccination:2
Submitted: 1990-10-02
   Days after onset:41
Entered: 1990-10-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH 1211A / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0611E / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Gastrointestinal disorder, Sudden infant death syndrome, Weight increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-08-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None w/exception of Regurgitation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy reported as SIDS w/ cardiomyopathy per Dr.
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV child presented for well child exam 20Aug90. Only concerns noted were precipitous weight gain & intermittant regurgitation of Prosobee.


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