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This is VAERS ID 28091

Case Details

VAERS ID: 28091 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Virginia  
Vaccinated:1990-10-09
Onset:1990-10-09
   Days after vaccination:0
Submitted: 1991-02-07
   Days after onset:121
Entered: 1991-02-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283914 / 1 RL / -

Administered by: Private       Purchased by: Private
Symptoms: Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-10-14
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: lt congenital hip dysplasia
Allergies:
Diagnostic Lab Data: Cause of death SIDS - no autopsy performed.
CDC Split Type:

Write-up: Died 5 days p/1st DTP vax; Noticed spitting-up increased p/vax.


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