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This is VAERS ID 107742

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 107742 (history)  
Form: Version .0  
Age: 0.1  
Sex: Male  
Location: North Carolina  
Vaccinated:1998-01-22
Onset:1998-02-07
   Days after vaccination:16
Submitted: 1998-02-11
   Days after onset:4
Entered: 1998-02-19
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS M305NP / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES 0766H / 0 - / PO

Administered by: Public       Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome
SMQs:, Ischaemic cerebrovascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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: NA
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type: NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


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