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This is VAERS ID 89957

Case Details

VAERS ID: 89957 (history)  
Form: Version 1.0  
Age: 1.5  
Sex: Male  
Location: Arizona  
Vaccinated:1996-09-09
Onset:1996-09-09
   Days after vaccination:0
Submitted: 1996-09-11
   Days after onset:2
Entered: 1996-09-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 436792 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 204392 / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0394D / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0738C / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-09-09
   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: 10DEC95 sz;virus
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt dead-autopsy inconclusive @ this time;


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