VAERS ID: 100228

AGE: 0.1| SEX: F|STATE: NY (United States)

Description

pt recv vax; was found not breathing; brought to hosp; pt pronounced dead on arrival; presumed SIDS 6 days posy vax;

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Symptoms

Apnoea, Sudden infant death syndrome

Vaccines

VAX DATE: 06-30-1997| ONSET DATE: 07-06-1997| DAYS TO ONSET: 6
NameDose #TypeManufacturerLotRouteSite
HIB (HIBTITER) 1 HIBV PFIZER\WYETH M300PN LL
POLIO VIRUS, INACT. (NO BRAND NAME) 1 IPV PASTEUR MERIEUX INST. M0443 SC LA
DTAP (TRIPEDIA) 1 DTAP CONNAUGHT LABORATORIES 7J81535 RL

RECVDATE:07-15-1997
RPT_DATE:07-10-1997
CAGE_YR:0
CAGE_MO:0.1
DIED:Y
DATEDIED:07-06-1997
L_THREAT:Y
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:Y
RECOVD:N
LAB_DATA:none
V_ADMINBY:PVT
OTHER_MEDS:none
CUR_ILL:none
HISTORY:none
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:PVT

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