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: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. |
1163A / 0 |
RL / - |
Administered by: Private Purchased by: Public Symptoms: Congenital anomaly,
Cyst,
Sudden infant death syndrome,
Unevaluable event SMQs:, Congenital, familial and genetic disorders (narrow), 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: ~ ()~~~In patient Other Medications: Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: NH9634
Write-up: SIDS |