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This is VAERS ID 26297

Case Details

VAERS ID: 26297 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Vermont  
Vaccinated:1989-12-14
Onset:1990-01-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259943 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Brain oedema, Hypoxia, Infection, Lung disorder, Petechiae, Respiratory disorder, Sudden infant death syndrome
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-01
   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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001636.01

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 14DEC89 and died 1JAN90.


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