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This is VAERS ID 30143

Case Details

VAERS ID: 30143 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Male  
Location: Tennessee  
Vaccinated:1991-02-27
Onset:1991-03-03
   Days after vaccination:4
Submitted: 1991-03-08
   Days after onset:5
Entered: 1991-04-26
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 289963 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 291947 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-03
   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:
Current Illness: Infant had an ear infect 2 wks prior vax
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: TN9153

Write-up: Autopsy performed, cause of death determined to be sudden infant death synd;


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