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This is VAERS ID 28827

Case Details

VAERS ID: 28827 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Female  
Location: Oregon  
Vaccinated:1991-02-07
Onset:1991-02-09
   Days after vaccination:2
Submitted: 1991-02-21
   Days after onset:12
Entered: 1991-03-05
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 283914 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670FC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0619B / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Sudden infant death syndrome, Vasodilatation
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Neonatal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy report documented SIDS as cause of death
CDC Split Type: OR915

Write-up: 9FEB91 @ 8P parents remembered that Pt. was fussy & felt hot. Continued to feel hot & wake up every hr through the night.


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