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This is VAERS ID 28070

Case Details

VAERS ID: 28070 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: South Dakota  
Vaccinated:1990-10-12
Onset:1990-10-15
   Days after vaccination:3
Submitted: 1991-01-10
   Days after onset:87
Entered: 1991-02-12
   Days after submission:33
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285920 / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614E / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-15
   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: None
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy report- Mild inflammatory change w/in liver, Mild nonspecific respiratory or gastrointestinal infect; No evidence of underlying trauma. No evidence to suggest any element of abuse and/or neglect.
CDC Split Type: SD91002

Write-up: SIDS.


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