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This is VAERS ID 107712

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 107712 (history)  
Form: Version .0  
Age: 0.5  
Sex: Female  
Location: New Mexico  
Vaccinated:1998-02-06
Onset:1998-02-07
   Days after vaccination:1
Submitted: 1998-02-09
   Days after onset:2
Entered: 1998-02-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 826A2 / 2 LL / IM
HEP: RECOMBIVAX HB / MSD 0748E / 2 RL / IM
HIBV: PEDVAXHIB / MSD 0535E / 2 LL / IM
OPV: ORIMUNE / LEDERLE 0772K / 2 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: AGITATION, CHILLS, INSOMNIA, SIDS, SKIN DISCOLOR
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-02-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=107712


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