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This is VAERS ID 28519

Case Details

VAERS ID: 28519 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Illinois  
Vaccinated:1990-11-29
Onset:1990-12-16
   Days after vaccination:17
Submitted: 1991-02-01
   Days after onset:47
Entered: 1991-03-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283913 / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 285949 / 2 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: 1990-12-16
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: IL913

Write-up: SIDS- 16DEC90.


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