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This is VAERS ID 29345

Case Details

VAERS ID: 29345 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-28
Onset:1991-02-03
   Days after vaccination:6
Submitted: 1991-02-16
   Days after onset:13
Entered: 1991-03-25
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M730FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 289945 / 1 MO / PO

Administered by: Other       Purchased by: Unknown
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-03
   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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WA91529

Write-up: Crib Death- SIDS;


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