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This is VAERS ID 29990

Case Details

VAERS ID: 29990 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-01-28
Onset:1991-01-30
   Days after vaccination:2
Submitted: 1991-04-02
   Days after onset:62
Entered: 1991-04-19
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 283912 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH MC507B / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0625A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-30
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 910071301

Write-up: 2mos pt recvd DTP/OPV/Hibtiter on 28Jan91. Found in crib on 30Jan91-unable to resuscitate.No intervening illness.Preliminary autopsy report, no pathology, probable SIDS


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