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This is VAERS ID 26209

Case Details

VAERS ID: 26209 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Unknown  
Location: North Carolina  
Vaccinated:1990-09-11
Onset:1990-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 268910 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0608E / UNK MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-09-13
   Days after onset: 2
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: Autopsy pending - copy of report requested
CDC Split Type: 9001603.01

Write-up: Pt vaccinated /w DTP/OPV & died same evening. Prior to death, infant was alone & had been drinking from a bottle of milk, found non-responsive. Taken to ER- pronounced dead on arrival. There was some possible aspiration.


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