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This is VAERS ID 27246

Case Details

VAERS ID: 27246 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1990-12-14
Onset:1990-12-15
   Days after vaccination:1
Submitted: 1990-12-17
   Days after onset:2
Entered: 1990-12-31
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287951 / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Cyanosis, Hypotonia, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-12-15
   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: This was an adopted infant born at Tacoma General Hosp
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA90499

Write-up: Pt vac w/ DTP/OPV had norm 4 mo well baby exam; Next day found limp & cyanotic. Brought to ER by paramedics, no signs of life after usual resuscitation measures. Possible SIDS. 06FEB91: AUTOPSY REPORT RECEIVED FROM SHC; DX = SIDS


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