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This is VAERS ID 27690

Case Details

VAERS ID: 27690 (history)  
Form: Version 1.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:1991-01-18
Onset:1991-01-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1991-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21173 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FD / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-25
   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: High T-4 lst PKU - Normal testing results rec.
Allergies:
Diagnostic Lab Data: Autopsy Done-no results at this time
CDC Split Type:

Write-up: Child rec 1st DTP shot OPV & HIBtiter vax on 18JAN91, child expired on 25JAN91 cause of death unknown at this point autopsy done - no results at this time 30JAN91


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