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This is VAERS ID 113440

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

Case Details

VAERS ID: 113440 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Ohio  
Vaccinated:1998-07-21
Onset:1998-07-22
   Days after vaccination:1
Submitted: 1998-07-24
   Days after onset:2
Entered: 1998-08-18
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 451498 / 0 RL / IM
HBHEPB: COMVAX / MSD 0326H / - LL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0147 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-22
   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
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NONE

Write-up: SIDS;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=113440


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