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This is VAERS ID 35692

Case Details

VAERS ID: 35692 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Illinois  
Vaccinated:1991-09-17
Onset:1991-09-19
   Days after vaccination:2
Submitted: 1991-10-12
   Days after onset:23
Entered: 1991-10-21
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 1D21000 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M130HA / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 623K4 / 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: 1991-09-19
   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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No sx in 1st 24 hrs p/immun; pt found dead in crib on morning of 19SEP91 approx 48hrs p/vax; SIDS dx p/exam in ER @ Hosp & autopsy;


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