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This is VAERS ID 27691

Case Details

VAERS ID: 27691 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Minnesota  
Vaccinated:1991-01-17
Onset:1991-01-23
   Days after vaccination:6
Submitted: 1991-01-24
   Days after onset:1
Entered: 1991-02-01
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0A21149 / 3 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 2 RL / IM

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: 1991-01-23
   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: Septra
Current Illness: otitis media
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy - no evidence for abnormalities.
CDC Split Type:

Write-up: Crib Death; Felt to be sids.


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