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This is VAERS ID 35089

Case Details

VAERS ID: 35089 (history)  
Form: Version 1.0  
Age: 0.3  
Sex: Female  
Location: New Hampshire  
Vaccinated:1991-06-17
Onset:1991-07-07
   Days after vaccination:20
Submitted: 1991-09-24
   Days after onset:79
Entered: 1991-09-30
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 297909 / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0173T / 2 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0632C / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-07-07
   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-SIDS
CDC Split Type:

Write-up: spitting up day before death, no diarrhea, fever;


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