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This is VAERS ID 27309

Case Details

VAERS ID: 27309 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: California  
Vaccinated:1990-12-06
Onset:1990-12-12
   Days after vaccination:6
Submitted: 1990-12-21
   Days after onset:9
Entered: 1991-01-04
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291930 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285951 / 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: 1990-12-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pathology report by Hosp.
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV sudden infant death.


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