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This is VAERS ID 28321

Case Details

VAERS ID: 28321 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-02-05
Onset:1991-02-06
   Days after vaccination:1
Submitted: 1991-02-07
   Days after onset:1
Entered: 1991-02-15
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285918 / 1 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200FE / 1 LL / -
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: 1991-02-06
   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 poss.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy-$g no cause found
CDC Split Type:

Write-up: sids death 16-24 hrs /p administration of imm.


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