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This is VAERS ID 108077

(NOTE: This result is from the 6/14/2018 version of the VAERS database)

Case Details

VAERS ID: 108077 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Texas  
Vaccinated:1997-04-28
Onset:1997-04-28
   Days after vaccination:0
Submitted: 1997-05-09
   Days after onset:11
Entered: 1998-02-23
   Days after submission:290
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome
SMQs:, Acute central respiratory depression (narrow), Neonatal disorders (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-04-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC Split Type: 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


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