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This is VAERS ID 114918

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

Case Details

VAERS ID: 114918 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Connecticut  
Vaccinated:1998-09-11
Onset:1998-09-30
   Days after vaccination:19
Submitted: 1998-10-07
   Days after onset:7
Entered: 1998-10-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 447788 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-09-30
   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~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: apparent SIDS 30SEP98 final autopsy pending;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=114918


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