VAERS ID: 25535

AGE: 0.3| SEX: M|STATE: OH

Description

normal 4 moth old infant received DTP/OPV in office at on 28Mar90, put to bed at 10:00pm; found dead at 10:30 pm.

Symptoms

Sudden infant death syndrome

Vaccines

VAX DATE: 03-28-1990| ONSET DATE: 03-28-1990| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
DTP (TRI-IMMUNOL) 2 DTP LEDERLE LABORATORIES 271962 Unknown Unknown
POLIO VIRUS, ORAL (ORIMUNE) 2 OPV PFIZER\WYETH 259949 Unknown Unknown

RECVDATE:07-16-1990
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:03-28-1990
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Autopsy revealed no pathology in any organ system that could explain the death of this infant, therefore, this is a case of sudden death syndrome.
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:~ ()~~~In patient
SPLTTYPE:9000592.01
FORM_VERS:1
TODAYS_DATE:
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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