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This is VAERS ID 34482

Case Details

VAERS ID: 34482 (history)  
Form: Version 1.0  
Age: 0.1  
Sex: Male  
Location: New Jersey  
Vaccinated:1991-07-31
Onset:1991-08-01
   Days after vaccination:1
Submitted: 1991-08-02
   Days after onset:1
Entered: 1991-09-03
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 1D2100 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 298951 / 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: 1991-08-01
   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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy-medical examiner 2AUG91
CDC Split Type: NJ9116

Write-up: Pt found dead during sleep 01AUG91; preliminary ME report SIDS:


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