VAERS ID: 100174

AGE: 0.2| SEX: F|STATE: WA (United States)

Description

death 11FEB97 6PM;autopsy result SIDS: autopsy report given pathological dx SIDS w/intrathoracic visceral petechiae, visceral congestion & minute foci of early bronchopenumonia;

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Symptoms

Pneumonia, Sudden infant death syndrome, Petechiae, Gastrointestinal disorder

Vaccines

VAX DATE: 02-07-1997| ONSET DATE: 02-11-1997| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
POLIO VIRUS, ORAL (ORIMUNE) 0 OPV PFIZER\WYETH 441188 Unknown Unknown
HEP B (RECOMBIVAX HB) 0 HEP MERCK & CO. INC. 1131D Unknown Unknown
DTP + HIB (TETRAMUNE) 0 DTPHIB PFIZER\WYETH 441098 Unknown Unknown

RECVDATE:07-14-1997
RPT_DATE:02-18-1997
CAGE_YR:0
CAGE_MO:0.2
DIED:Y
DATEDIED:02-11-1997
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:autopsy performed 12FEB97;
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:mild URI
HISTORY:NONE
PRIOR_VAX:
SPLTTYPE:WA971364
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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