VAERS ID: 100264

AGE: 0.2| SEX: M|STATE: FR (Unknown)

Description

it was reported that pt recv vax 1MAY97 & 3MAY97 pt died;

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Symptoms

Sudden infant death syndrome

Vaccines

VAX DATE: 05-01-1997| ONSET DATE: 05-03-1997| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
DTP (NO BRAND NAME) 1 DTP Unknown Unknown Unknown
HIB (ACTHIB) 1 HIBV CONNAUGHT LABORATORIES Unknown Unknown

RECVDATE:07-16-1997
RPT_DATE:07-15-1997
CAGE_YR:0
CAGE_MO:0.2
DIED:Y
DATEDIED:05-03-1997
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:CO7413
FORM_VERS:
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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