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This is VAERS ID 108977

(NOTE: This result is from the 10/14/2018 version of the VAERS database)

Case Details

VAERS ID: 108977 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New Hampshire  
Vaccinated:1997-01-08
Onset:1997-01-22
   Days after vaccination:14
Submitted: 1998-03-01
   Days after onset:403
Entered: 1998-03-31
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1997-01-22
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH97

Write-up: undetermined cause of death;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=108977


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