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This is VAERS ID 113721

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

Case Details

VAERS ID: 113721 (history)  
Form: Version .0  
Age: 0.3  
Sex: Male  
Location: New Jersey  
Vaccinated:1998-08-14
Onset:1998-08-23
   Days after vaccination:9
Submitted: 1998-08-26
   Days after onset:3
Entered: 1998-09-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 934790 / 1 RL / IM
HIBV: ACT-HIB / CONNAUGHT LABS 2699H2 / 1 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0492 / 1 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: SLEEP POSITION
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-08-23
   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: NONE
Allergies:
Diagnostic Lab Data: gross autopsy reported to have shown no identifiable cause of death;pathology/tissue report pending;
CDC Split Type:

Write-up: pt found lifeless in bed;head reported to have been wedged between mattress & wall;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=113721


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