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This is VAERS ID 108795

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

Case Details

VAERS ID: 108795 (history)  
Form: Version .0  
Age: 0.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:1996-04-13
Onset:1996-04-28
   Days after vaccination:15
Submitted: 1998-03-19
   Days after onset:690
Entered: 1998-03-24
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: RECOMBIVAX HB / MSD 1163A / 0 RL / -

Administered by: Private       Purchased by: Unknown
Symptoms: ANOMALY CONGEN, CYST, SIDS, SLEEP PAR BED
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1996-04-28
   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:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=108795


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