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This is VAERS ID 30428

Case Details

VAERS ID: 30428 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:1991-01-28
Onset:1991-01-29
   Days after vaccination:1
Submitted: 1991-01-30
   Days after onset:1
Entered: 1991-05-13
   Days after submission:102
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285916 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M705FE / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0623H / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Apnoea, Cardiac failure, Coma, Haemorrhage, Petechiae, Respiratory disorder, Stupor, Sudden infant death syndrome
SMQs:, Cardiac failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-01-29
   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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NV9105

Write-up: Appeared well when immun given; Was found by babysitter w/out respiration & pulse; Paramedics called - vomitus in nares & throat; Pronounced DOA @ Hosp Fr Death Certificate: cause of death-SIDS;


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