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This is VAERS ID 110009

(NOTE: This result is from the 5/14/2017 version of the VAERS database)

Case Details

VAERS ID: 110009 (history)  
Form: Version .0  
Age: 0.1  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1998-03-26
Onset:1998-03-27
   Days after vaccination:1
Submitted: 1998-04-16
   Days after onset:19
Entered: 1998-04-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 0 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 0 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-27
   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: NONE
Current Illness: NONE
Preexisting Conditions: +suspected sepsis @ birth treated x 7 days
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: pt recv vax 26MAR98 & died 27MAR98;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170514&IDNUMBER=110009


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