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From the 10/15/2021 release of VAERS data:

Found 3,107 cases where Patient Died and Vaccination Date from '2007-08-01' to '2020-11-30'



Case Details

This is page 9 out of 311

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VAERS ID: 306062 (history)  
Form: Version 1.0  
Age: 0.38  
Sex: Male  
Location: Colorado  
Vaccinated:2008-01-30
Onset:0000-00-00
Submitted: 2008-02-28
Entered: 2008-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0077U / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70143B / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1128U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-06
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Death 2/6/08. 3/18/08 Reviewed autopsy report which states COD as SIDS. Autopsy states patient found face down atop baby blankets on floor. Autopsy findings insufficient to explain death. PMH: viral URI 1/2008. No other recent illlness or sick contacts. Birth history unremarkable.


VAERS ID: 306283 (history)  
Form: Version 1.0  
Age: 75.0  
Sex: Female  
Location: Arizona  
Vaccinated:2008-02-19
Onset:2008-02-21
   Days after vaccination:2
Submitted: 2008-03-03
   Days after onset:11
Entered: 2008-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1382U / 2 UN / SC
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. 1413U / 2 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Coumadin; lisinopril; Digoxin; cholesterol; CRT
Current Illness: Sinusitis. 4/30/2008 Most recent H&P received for DOS 2/19/2008 with DX:Sinusitis, ST (sore throat?), Congestion. Pt presented with hx of a cold which got worse. Pt c/o sinus pain and pressure as well as facial pain. Requested Shingles vax and Pneumovax. PE (+) for reddened turbinates and pharynx and enlarged nodes. Txd with Nasonex& Z-pack.
Preexisting Conditions: Heart valve disease; HTN; increased chol. PMH: Seen by cardiologist 2 months prior. "All good with valves". 5/07/2008 MR received from most recent cardiac eval done 1/31/2008. PMH: Mitral Valve repair 1991, hypertension, chronic atrial fibrillation and hyperlipidemia. Labs and Diagnostics: ECG (+) for A fib and occ PVC. Echo (+) for biatrial enlargement, R ventricular enlargement, EF 45%. Abd US (+) atherosclerotic abdominal aorta, no aneurysmal dilitation. CBC with platelets 105, otherwise WNL. Lipid panel WNL. CMP unremarkable. Impression: As per PMH.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died in her sleep 48 hrs after receiving vaccinations. I do not think related but close time frame with vaccination. We just wanted to inform you (and family). Autopsy pending. Final COD: Mitral Valve Disease. (no autopsy done).


VAERS ID: 306386 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: Colorado  
Vaccinated:2008-02-22
Onset:2008-03-01
   Days after vaccination:8
Submitted: 2008-03-04
   Days after onset:3
Entered: 2008-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B132CA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF224AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015H / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1244U / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Constipation, Diarrhoea, Erythema, Gastrointestinal haemorrhage, Hyperhidrosis, Hypersomnia, Injection site erythema, Muscle rigidity, Opisthotonus, Pyrexia, Screaming, Thymus enlargement
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (narrow), Parkinson-like events (narrow), Gastrointestinal haemorrhage (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad), Neonatal disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: death~DTaP + HepB + IPV (Pediarix)~1~0.30~Patient
Other Medications: Tylenol
Current Illness: none
Preexisting Conditions: none BIRTH Hx: NSVD at term w/o complication. Patient & parent positive for THC at birth. Salmonella at 1 mo. Stomach flu w/vomiting, diarrhea & fever 2/12/08 lasting 3-5 days.
Allergies:
Diagnostic Lab Data: swollen and red thymus others still pending
CDC Split Type:

Write-up: Shrill screaming, arched back, fever, excessive sleeping, rigid, cried when touched, red where shots were administered, sweating, constipation/diarrhea resulting in bowel area bleeding all resulting in death. 3/13/08 PCP medical records reviewed which reveal patient subjected to second hand smoke. 1/31/08 vs had nasal congestion, irritability, cough, red throat. No treatment Rx. Returned to office 2/12 w/vomiting, diarrhea, fever, diet refusal. Dx: dehydration & tx w/fluids & antipyretics. Returned to office 2/22/08, found to be healthy & vaccines given. 4/4 Autopsy report states COD as SIDS & manner of death as natural. Report reveals parent was smoker. Patient lived w/single parent & dog. Patient placed in crib in own bedroom on side w/swaddling blanket. Found face down in center of crib, cyanotic & limp w/very small amount of pink tinged sputum 3 hrs later. Ambulance to ER momentarily got vitals but resuscitation ultimately unsuccessful. Investigative notes from PCP indicate patient had period of brief screaming w/rigidity followed by listlessness & lethargy 24-48 hrs after shots.


VAERS ID: 306548 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Missouri  
Vaccinated:2007-10-24
Onset:0000-00-00
Submitted: 2008-03-05
Entered: 2008-03-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF184AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08700D / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1152U / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-10-27
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown PMH: FT previously health infant
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0802USA05956

Write-up: Information has been received from a physician concerning a 2 month old male with no drug allergies who was vaccinated PO with his first 2.0 ml dose of ROTATEQ (no lot# available). Suspect vaccination administered on the same day included a dose of Hib conj vaccine (OMPC) (manufacturer unknown). Concomitant vaccinations administered the same day included a dose of PEDIARIX and a dose of PREVNAR. Three days after vaccination, the patient died (specific date of death unknown). The cause of death was sudden death syndrome. There was no product quality complaint. Additional information has been requested. 4/18 Spoke w/physician who provided corrected patient name, DOB, DOD, date of vaccination & ME contact #. States prelim COD is SIDS. 8/5/08 Autopsy states COD as sudden unexpected death by suffocation & manner of death as accident. Patient found in crib face down w/mouth & nose in full contact w/bedding lying in ''pool'' of blood tinged emesis not breathing. CPR started & EMS responded. Arrived in ER in full arrest & unable to be resuscitated.


VAERS ID: 306734 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Idaho  
Vaccinated:2007-12-31
Onset:2008-01-08
   Days after vaccination:8
Submitted: 2008-03-05
   Days after onset:57
Entered: 2008-03-10
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2382BA / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2771AA / UNK RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio normal, Aspartate aminotransferase normal, Blood alkaline phosphatase normal, Blood bilirubin, Blood creatine phosphokinase normal, Cardiac arrest, Globulin, Hypertrophic cardiomyopathy, Inappropriate schedule of drug administration, Myoglobin blood increased, Sudden death, Troponin, Ventricular fibrillation
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (broad), Cardiomyopathy (narrow), Respiratory failure (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-01-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None PMH: sibling w/VSD repair. PE tubes @3yo.
Allergies:
Diagnostic Lab Data: Globulin 2.3 1.8-3.5 g/dl; ALB/Glob ratio 1.4 1.0-2.7 ratio; Bilirubin, TOT 0.2 <2.0 mg/dl; ALT 21 5-50 u/L; ALK Phos 144 103-429 u/L; AST 30 14-40 u/L; CK, TOT 161 25-287 u/L; Myoglobin 147 (high) LT 65 ng/ml; Troponin-T <0.01 0.00-0.10 ng/ml. LABS: in ER, venous pH 6.94 (L), CO2 16 (L), serum myoglobin 147 (H), anion gap 23 (H), glucose 278 (H), total protein 5.7 (L), albumin 3.3 (L).
CDC Split Type:

Write-up: Sudden death on school playground. 3/11/08 Reviewed medical records that accompanied autopsy report which reveal patient who appeared large for his age was involved in after school snow ball fight w/friends then ran across street approx 50 yards to parent''s vehicle & collapsed over the car. Parent & other bystanders witnessed event & called 911. Parent told ER patient was gurgling, color drained from face & eyes glassed over. Transported to ER where resuscitation unsuccessful. 3/25/08 Reviewed pcp medical records of 12/31/07. Only complaint was of slight pain right knee s/p bike crash. Pt wt 148 lbs, ht 63.5 in, BMI 25.8. BP 100/60. Vax record supplies lot #. Family hx: parent w/HTN.


VAERS ID: 306817 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Illinois  
Vaccinated:2008-02-23
Onset:2008-02-27
   Days after vaccination:4
Submitted: 2008-03-03
   Days after onset:5
Entered: 2008-03-11
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0808U / 1 LL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1491U / 1 RL / SC

Administered by: Private       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-27
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None Performed. Labs: Microscopic exam (+) for foci of neutrophils and eosinophils in walls of bronchi and scattered neutrophils in peribronchiolar alveoli; congestion. Otherwise NPC. Blood cx (+) for Enterobacter aerogenes, Enterobacter cloacae, Staph aureus, and Virididans streptococcus group. Blood glucose 132. Creatinine 0.0. K+ 16.0. Cl- 116
CDC Split Type:

Write-up: On 2/23/08 child received MMR and Varicella vaccinations during routine one year check up. No adverse events reported to physician prior to death on 2/27/08. 6/25/2008 Postmortem examination report received. COD-Acute Febrile Illness. DX based on exam: Pale doughy lungs. Bite marks on lower lip. Febrile illness by history. Acute inflammatory cells in walls of bronchi in peribronchial alveoli.


VAERS ID: 306983 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: North Carolina  
Vaccinated:2007-11-14
Onset:2007-11-20
   Days after vaccination:6
Submitted: 2007-11-21
   Days after onset:1
Entered: 2008-03-13
   Days after submission:112
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0259U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B087008 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Blood ethanol normal
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-11-20
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Neg for ethanol
CDC Split Type:

Write-up: Arrived @ ER in cardiac arrest @ 6pm apparently choked while being fed. Autopsy Dx = SIDS. 3/17/08-Autopsy report received-COD-Sudden Infant Death Syndrome. Apparently had been healthy. Parent had been lying on bed with child feeding it with a bottle when both he and the child apparently went to sleep. The 4 year old sibling noticed child was face down in crook of parent''s arm and turned the child and woke father. Autopsy revealed a normally developed and well cared for appearing child, no evidence of injury, no congential or acquired condition that might explain her death was found. The circumstances raise the possibilty of accidental asphyxia but it does not appear from account available that in the position described the child''s breathing would necessarily be compromised.


VAERS ID: 307009 (history)  
Form: Version 1.0  
Age: 6.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2008-02-27
Onset:2008-02-29
   Days after vaccination:2
Submitted: 2008-03-13
   Days after onset:12
Entered: 2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB200B / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1472U / 2 LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Chest X-ray abnormal, Death, Laboratory test abnormal, Mental status changes, Respiratory distress, Viral test positive, Virus culture positive
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-03-02
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: swollen lips~Influenza (Seasonal) (Fluzone)~~0.00~In Patient
Other Medications: Aspirin, Gabapentin, Amoxicillin, Albuterol, Clonazepam and Prevacid
Current Illness: None - Patient has multiple chronic medical issues but was well appearing at time of clinic visit.
Preexisting Conditions: Congenital Heart Disease, Cerbral Palsy, Asplenia PMH: situs invernus; profound developmental delay; cerebral palsy from chronic ischemia; Hypotonia; failure to thrive; non-verbal; GERD; oral motor function; sleep dysfunction. Allergies: apples, milk, strawberries, benadryl, reglan. PMH: heterotaxy syndrome; dextrocardia; single ventricle physiology; asplenia; s/p Fontan completion 2004. G-tube fed & w/c bound. 2006 records reveal patient w/G-tube for several years. Recurrent pneumonias. -Allergic reactions to beef broth & flu vaccine.
Allergies:
Diagnostic Lab Data: Viral studies and Chest xray showed left lower lobe pneumonia LABS: rapid test for influenza B (+). Initial WBC 3,000 & chemistry WNL. CT of brain w/severe cerebral edema & transtentorial herniation. LABS: CXR LLL pneumonia.
CDC Split Type:

Write-up: Patient received Hepatitis A and Varicella vaccines 2 days prior to presenting to the ED with respiratory distress and mental status changes. The patient died 3 days later from influenza B. There is no indication that the vaccines this patient received or any other vaccine could have had any relationship to the outcome, or is there any reason to believe from the history that anything other than the influenza and the patients underlying medical condition (Congential Heart Disease, Asplenia, CP) were related to the death. However, we report all incidents of patients with a serious adverse event temporarily related to vaccine administration, whether or not there is a relationship. 6/2/08 Reviewed hospital discharge/death summary for 2/29-3/2/2008, FINAL DX: overwhelming influenza B sepsis & encephalopathy Records reveal patient experienced labored breathing, altered mental status x 1 day; coughing, rhinorrhea & fever x 2 days. Seen by PCP & dx w/viral illness. Conditioned worsened & became unresponsive at home. Taken to ER by EMT with oxygen saturation 70''s (baseline high 80''s). In ER, noted to have frothy sputum. Tx w/CPAP & nebs. Improved & became responsive. Then after another episode of bradycardia & hypotension, became unreponsive again. Felt to be having sub-clinical seizures. Admitted to PICU, intubated & coded several times. On multiple pressors w/fixed & dilated pupils. Family requested no further resuscitation efforts. ME declined case & family declined autopsy. 6/3/08 Reviewed medical records for 2006 & additional medical records for 2008. Records for 2/15-3/2/2008 reveal patient in usual state of health on day of vaccination. Seen by PCP 2/29 w/fever 103.3 for 1-2 days; had not received flu shot due to prior facial swelling w/flu vaccine in 2006. Dx w/viral illness. Seen in ER later same day for cough, rhinorrhea & fever x 2 days & increased respiratory effort becoming unresponsive. Admitted to PICU w/influenza w/pneumonia; respiratory failure; & congenital heart disease. Neuro & cardio consults done.


VAERS ID: 307156 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Female  
Location: Connecticut  
Vaccinated:2008-02-09
Onset:2008-02-25
   Days after vaccination:16
Submitted: 2008-03-11
   Days after onset:14
Entered: 2008-03-17
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B125CB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0498U / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B540134 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0902U / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Autopsy, Death, Epistaxis, Haemorrhage, Petechiae, Pulse absent, Resuscitation
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synagis; TriViSol Vitamins
Current Illness: None - healthy and thriving
Preexisting Conditions: Former 32 week preemie (she was co-sleeping with mom at time of cardio-pulmonary failure) 4/18/08-autopsy report received-history of co-sleeping with an adult.
Allergies:
Diagnostic Lab Data: Medical Examiner autopsy - report pending - by verbal report - "petechial hemorrhages" and blood in nose
CDC Split Type:

Write-up: On 2/25/08 infant breastfed well at 3 AM. At approximately 6 AM 2/25/08 infant was found with blood in nose, apneic and pulseless; 911 called, fail resuscitation attempted. Infant was declared dead at hospital ED after failed attempt to revive her. She was a former 32 week preemie who slept in same bed with parents. 4/18/08-autopsy report received: Cause of Death:Sudden unexplained infant death in infancy.


VAERS ID: 307157 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Male  
Location: Arkansas  
Vaccinated:2008-01-03
Onset:2008-02-14
   Days after vaccination:42
Submitted: 2008-03-14
   Days after onset:28
Entered: 2008-03-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015L / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0669U / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-02-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: None available. Autopsy pending.
CDC Split Type:

Write-up: Infant reported in paper as deceased. No contact with parents. PHN who gave vaccine had remembered that infant died and had received immunizations from local health unit on 010308. This was triggered by report of another infant in same county who dies at 3 mo. of age and was given same vaccines but with different lot #s of some vaccines.


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