VAERS ID: 25530

AGE: 0.3| SEX: M|STATE: IN

Description

Pt had low grade fever & fussiness within 12 hrs /p vaccination, slept well that evenig. Following moring infant was fine; taken to babysitter and was placed in crib for nap. Infant was found dead ar 1:00 pm. Autospy report list SIDS

Symptoms

Agitation, Pyrexia, Sudden infant death syndrome

Vaccines

VAX DATE: 06-04-1990| ONSET DATE: 06-04-1990| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
DTP (TRI-IMMUNOL) Unknown DTP LEDERLE LABORATORIES 262913 IM Unknown

RECVDATE:07-16-1990
RPT_DATE:
CAGE_YR:0
CAGE_MO:0.3
DIED:Y
DATEDIED:06-05-1990
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:no relevant hx, no siblings
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:9001011.01
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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