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This is VAERS ID 113721

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 113721 (history)  
Form: Version 1.0  
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: 1998-08-31
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 934790 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 2699H2 / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0492 / 2 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Unevaluable event
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: ~ ()~~~In patient
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=20170914&IDNUMBER=113721


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