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This is VAERS ID 118639

Case Details

VAERS ID: 118639 (history)  
Form: Version 1.0  
Age: 1.19  
Sex: Male  
Location: California  
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted: 1999-02-01
Entered: 1999-02-09
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1999-01-28
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC Split Type:

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


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