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This is VAERS ID 30450

Case Details

VAERS ID: 30450 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: California  
Vaccinated:1991-04-23
Onset:1991-04-24
   Days after vaccination:1
Submitted: 1991-04-26
   Days after onset:2
Entered: 1991-05-13
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 295978 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M105HA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0268B / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-04-24
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 910090301

Write-up: 2mo infant rec''d DTP/OPV/HIBTITER on 23APR91; Found dead at the babysitter''s 24APR91;


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