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This is VAERS ID 35493

(NOTE: This result is from the 12/31/2003 version of the VAERS database)

Case Details

VAERS ID: 35493 (history)  
Form: Version .0  
Age: 0.2  
Sex: Male  
Location: Michigan  
Vaccinated:1991-10-02
Onset:1991-10-02
   Days after vaccination:0
Submitted: 1991-10-08
   Days after onset:6
Entered: 1991-10-17
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP MICH. PHD. / MICHIGAN DPH TR1214 / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M180HH / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0636B / 0 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: SIDS
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1991-10-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: h/o URI-looks fine
Preexisting Conditions: 2 beats clonus on feet; cranky/colicy infant
Allergies:
Diagnostic Lab Data: Autopsy pending;
CDC Split Type:

Write-up: Death from apparent SIDS; sudden infant Death Syndrome;


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20031231&IDNUMBER=35493


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