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This is VAERS ID 108799

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

Case Details

VAERS ID: 108799 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Washington  
Vaccinated:1998-03-17
Onset:1998-03-18
   Days after vaccination:1
Submitted: 1998-03-18
   Days after onset:0
Entered: 1998-03-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 2 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1484E / 2 RL / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 2 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Chills, Oral candidiasis, Otitis media, Stupor, Sudden infant death syndrome, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal infections (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-18
   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: Amox given 17MAR98;Nystatin oral susp
Current Illness: URI & OM
Preexisting Conditions: eczema & seborrhea dermatitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt found deceased in crib this AM <24hr p/vax;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=108799


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