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This is VAERS ID 34926

Case Details

VAERS ID: 34926 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Female  
Location: Virginia  
Vaccinated:1991-08-14
Onset:1991-08-17
   Days after vaccination:3
Submitted: 1991-09-10
   Days after onset:24
Entered: 1991-09-23
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306927 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HB / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 302938 / 2 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: 1991-08-17
   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: Sodium fluride drops-2 drops daily
Current Illness: well child
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Coroner''s report
CDC Split Type: VA91076

Write-up: Pt attended well peds clinic on 14AUG91; according to exam pt well that day & had no problems w/previous immun; DTP #2, OPV #2, HIB #2 given w/o difficulty; Mom given standard instr for fever control; Death occured 3 days later; dx SIDS;


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