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This is VAERS ID 27451

Case Details

VAERS ID: 27451 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1990-11-20
Onset:1990-11-29
   Days after vaccination:9
Submitted: 1991-01-08
   Days after onset:40
Entered: 1991-01-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0L11101 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M030FC / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619L / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-11-29
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SIDS investigation & autopsy done
CDC Split Type:

Write-up: Dx sudden infant death syndrome died 29Nov90


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