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This is VAERS ID 28826

Case Details

VAERS ID: 28826 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-16
Onset:1991-02-09
   Days after vaccination:24
Submitted: 1991-02-15
   Days after onset:6
Entered: 1991-03-05
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 271916 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705EF / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0614A / 1 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: 1991-02-09
   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: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC Split Type: OR913

Write-up: SIDS.


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