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This is VAERS ID 28826

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 28826 (history)  
Form: Version .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: 1991-03-13
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: TRI-IMMUNOL / LEDERLE 271916 / 0 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M705EF / 0 LL / -
OPV: ORIMUNE / LEDERLE 0614A / 0 - / PO

Administered by: Public       Purchased by: Unknown
Symptoms: SIDS
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:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 2 wks premie/C-section for mom''s eclampsia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=28826


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