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This is VAERS ID 28073

Case Details

VAERS ID: 28073 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Arizona  
Vaccinated:1990-12-19
Onset:1990-12-22
   Days after vaccination:3
Submitted: 1990-12-26
   Days after onset:4
Entered: 1991-02-12
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0F11081 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190FO / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291938 / 1 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: 1990-12-22
   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 sister; high fever; DTP/OPV; 1 dose.~ ()~~~In Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Resolved otitis media
Allergies:
Diagnostic Lab Data: Autopsy consistent with SIDS.
CDC Split Type:

Write-up: Baby found dead in crib early in tha AM on 22DEC90; Sudden Infant Death Syndrome.


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