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This is VAERS ID 29485

Case Details

VAERS ID: 29485 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: Washington  
Vaccinated:1991-01-25
Onset:1991-02-16
   Days after vaccination:22
Submitted: 1991-03-21
   Days after onset:33
Entered: 1991-04-01
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283970 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M090FF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0615E / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-02-16
   Days after onset: 0
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:
CDC Split Type: WA91532

Write-up: SIDS


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