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This is VAERS ID 26994

Case Details

VAERS ID: 26994 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1990-11-20
Onset:1990-11-22
   Days after vaccination:2
Submitted: 1990-12-06
   Days after onset:14
Entered: 1990-12-14
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285915 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 277949 / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PA907

Write-up: Pt vaccinated with DTP/OPV child in bed w/parents - not breathing - taken to ER Indiana. Autopsy done - Dx SIDS


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