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This is VAERS ID 29769

Case Details

VAERS ID: 29769 (history)  
Form: Version 1.0  
Age: 0.7  
Sex: Male  
Location: South Carolina  
Vaccinated:1991-03-04
Onset:0000-00-00
Submitted: 1991-03-25
Entered: 1991-04-05
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289901 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21131 / 1 LL / IM

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-23
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SC91032

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