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This is VAERS ID 27506

Case Details

VAERS ID: 27506 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Virginia  
Vaccinated:1991-01-08
Onset:1991-01-09
   Days after vaccination:1
Submitted: 1991-01-10
   Days after onset:1
Entered: 1991-01-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 293947 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291964 / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-09
   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: Tylenol drops PRN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: other pending autopsy at hospital. No lab work done 8JAN91
CDC Split Type: VA91001

Write-up: Pt vaccinated with DTP/OPV/HIB phone call from ER 9JAN91 at 1210PM requesting info re: child''s status on visit 8JAN91. Informed ER child well-given 2nd DTP, OPV & 1st HBCV - ER stated child "SIDS" found by mother - brought to ER via rescue.


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