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This is VAERS ID 113800

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

Case Details

VAERS ID: 113800 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Missouri  
Vaccinated:1998-07-25
Onset:1998-07-29
   Days after vaccination:4
Submitted: 1998-08-04
   Days after onset:6
Entered: 1998-09-01
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 456295 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1221E / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M255RJ / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0032 / 1 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Lung disorder, Petechiae, Sudden infant death syndrome
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-07-29
   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: variety done on post mortem exam;some still pending;
CDC Split Type: MO98041

Write-up: death certificate recv by hlth dept 30JUL;pt recv vax 25JUL98 per nurse @ local hosp;pt arrived DOA per pathologist probable cause of death SIDS;


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=113800


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