This is VAERS ID 110009

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

Case Details

VAERS ID:	110009 (history)
Form:	Version 1.0
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 / 1	RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH	M255RJ / 1	LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD.	N0032 / 1	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;

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20181014&IDNUMBER=110009