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This is VAERS ID 35493

(NOTE: This result is from the 9/14/2018 version of the VAERS database)

Case Details

VAERS ID: 35493 (history)  
Form: Version 1.0  
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: 1991-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH TR1214 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0636B / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Sudden infant death syndrome
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: ~ ()~~~In patient
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=20180914&IDNUMBER=35493


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