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This is VAERS ID 29256

Case Details

VAERS ID: 29256 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Illinois  
Vaccinated:1991-03-01
Onset:1991-03-02
   Days after vaccination:1
Submitted: 1991-03-05
   Days after onset:3
Entered: 1991-03-21
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 291928 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M670SH / 1 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0624M / 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: 1991-03-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: healthy
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Autopsy being performed. No report to date;
CDC Split Type: 910050501

Write-up: 3 mo infant rec''d DTP/HIBTITER/ORIMUNE 1MAR91; had no sx; Next morning 2MAR91 infant was found dead in crib by mom; autopsy is being performed;


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