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This is VAERS ID 29812

Case Details

VAERS ID: 29812 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Unknown  
Location: Texas  
Vaccinated:1991-03-06
Onset:1991-03-08
   Days after vaccination:2
Submitted: 1991-03-11
   Days after onset:3
Entered: 1991-04-08
   Days after submission:27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES - / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Infection, Myocarditis, Sudden infant death syndrome
SMQs:, Cardiomyopathy (broad), Neonatal disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PUB~ ()~~~In patient
Other Medications: NA
Current Illness: PUB
Preexisting Conditions: PUB
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: 910055001

Write-up: 2 mo infant rec''d DTP/OPV/HIBTITER on 6MAR91; Died 8MAR91; Reported as SIDS; Autopsy is being performed;pt found to have generalized viremia & viral myocarditis.Reporter states that death was not in any way related to immun.


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