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This is VAERS ID 26592

Case Details

VAERS ID: 26592 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Female  
Location: Tennessee  
Vaccinated:1990-10-03
Onset:1990-10-26
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 1990-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0J11070 / UNK - / IM

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: 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: Estrace Cream
Current Illness:
Preexisting Conditions: Premature birth 2lbs 13 oz
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC Split Type:

Write-up: Pt vaccinated with PROHIBIT DOA to Hosp.


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