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This is VAERS ID 30241

Case Details

VAERS ID: 30241 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-04-02
Onset:1991-04-04
   Days after vaccination:2
Submitted: 1991-04-04
   Days after onset:0
Entered: 1991-04-29
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 0C21045 / 1 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M680EN / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 628F1 / 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: 1991-04-04
   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: Well baby
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Request for Autopsy Report
CDC Split Type: CO3808

Write-up: Expired; suspect SIDS-brought to Hosp p/being found unresponsive by babysitter; No fever, irritability prior;


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