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This is VAERS ID 29272

Case Details

VAERS ID: 29272 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Oregon  
Vaccinated:1991-01-30
Onset:1991-02-25
   Days after vaccination:26
Submitted: 1991-03-08
   Days after onset:11
Entered: 1991-03-22
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0B21044 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M085FF / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0626F / 2 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: 1991-02-25
   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: Pierre/Robin synd; Cerebral Palsy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS Death;


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