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This is VAERS ID 30812

Case Details

VAERS ID: 30812 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Female  
Location: South Carolina  
Vaccinated:1991-03-13
Onset:0000-00-00
Submitted: 1991-05-17
Entered: 1991-05-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297906 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M640FN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 283943 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-03-14
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: Well Baby-viral URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC Split Type: SC91056

Write-up: Pt died on 14MAR91;


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