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This is VAERS ID 30005

Case Details

VAERS ID: 30005 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:1991-03-26
Onset:1991-03-27
   Days after vaccination:1
Submitted: 1991-03-27
   Days after onset:0
Entered: 1991-04-22
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285919 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M560FP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0622M / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-27
   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: Rondec DM drops
Current Illness: mild stuffy nose
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: NC91024

Write-up: Reported crib death;


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