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This is VAERS ID 112192

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 112192 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Mississippi  
Vaccinated:1998-03-12
Onset:1998-03-14
   Days after vaccination:2
Submitted: 1998-05-01
   Days after onset:47
Entered: 1998-06-29
   Days after submission:59
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7B91821 / 0 LL / -
HBHEPB: COMVAX / MSD 0571E / 0 RL / -
IPV: POLIOVAX / CONNAUGHT LTD M1070 / 0 RL / -

Administered by: Public       Purchased by: Unknown
Symptoms: SIDS, STUPOR
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-14
   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: unk
Current Illness: NONE
Preexisting Conditions: NONE-rash on face-oily-probably secondary to immature sweat gland
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: mom states tried to wake pt 14MAR98 but pt did not wake up;pt okay when went to sleep;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=112192


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