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This is VAERS ID 107742

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 107742 (history)  
Form: Version 1.0  
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 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome
SMQs:, Ischaemic central nervous system vascular 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~ ()~~~In patient
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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