VAERS ID: 100217

AGE: 0.4| SEX: F|STATE: NY (United States)

Description

pt found unresponsive in crib 3JUL97 230PM;

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Symptoms

Stupor, Sudden infant death syndrome

Vaccines

VAX DATE: 07-01-1997| ONSET DATE: 07-02-1997| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
POLIO VIRUS, ORAL (ORIMUNE) 2 OPV PFIZER\WYETH 766C1 PO MO
HIB (PROHIBIT) 2 HIBV CONNAUGHT LABORATORIES 7A91570 IM RL
HEP B (ENGERIX-B) 2 HEP SMITHKLINE BEECHAM 2250A2 IM LL
DTAP (TRIPEDIA) 2 DTAP CONNAUGHT LABORATORIES 7H81507 IM RL

RECVDATE:07-15-1997
RPT_DATE:07-11-1997
CAGE_YR:0
CAGE_MO:0.4
DIED:Y
DATEDIED:07-02-1997
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Autopsy: SIDS
V_ADMINBY:PVT
OTHER_MEDS:NONE
CUR_ILL:NONE
HISTORY:nONE
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:PVT

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