VAERS ID: 100310

AGE: 0.2| SEX: M|STATE: NE (United States)

Description

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Pulmonary oedema, Sudden infant death syndrome, Lung disorder, Petechiae

Vaccines

VAX DATE: 07-15-1997| ONSET DATE: 07-16-1997| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
POLIO VIRUS, ORAL (ORIMUNE) 0 OPV PFIZER\WYETH 436954 PO MO
DTP + HIB (TETRAMUNE) 0 DTPHIB PFIZER\WYETH 439192 IM LL
HEP B (ENGERIX-B) 2 HEP SMITHKLINE BEECHAM 2294A2 IM RL

RECVDATE:07-18-1997
RPT_DATE:07-17-1997
CAGE_YR:0
CAGE_MO:0.2
DIED:Y
DATEDIED:07-16-1997
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:pt recv HEP B vax by SKB lot# 2294A ;
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:

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