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This is VAERS ID 27161

Case Details

VAERS ID: 27161 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Massachusetts  
Vaccinated:1990-12-11
Onset:1990-12-12
   Days after vaccination:1
Submitted: 1990-12-17
   Days after onset:5
Entered: 1990-12-26
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MASS. PUB HLTH BIOL LAB DTP272 / UNK LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / UNK RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 287952 / UNK 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: 1990-12-12
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV/HIB died approx 24 hrs later. preliminary dx SIDS.


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