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This is VAERS ID 287915

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 287915
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B20510B / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Dilatation ventricular, Pulmonary oedema, Sleep disorder, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending


Changed on 12/8/2009

VAERS ID: 287915 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B20510B / 0 RL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Dilatation ventricular, Pulmonary oedema, Sleep disorder, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 3/2/2010

VAERS ID: 287915 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B20510B / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Dilatation ventricular, Pulmonary oedema, Sleep disorder, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 4/7/2010

VAERS ID: 287915 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B20510B / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Dilatation ventricular, Pulmonary oedema, Sleep disorder, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 8/31/2010

VAERS ID: 287915 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B20510B / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Dilatation ventricular, Pulmonary oedema, Sleep disorder, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 5/14/2017

VAERS ID: 287915 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Dilatation ventricular, Pulmonary oedema, Sleep disorder, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 9/14/2017

VAERS ID: 287915 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 0 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 2/14/2018

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 6/14/2018

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 8/14/2018

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 9/14/2018

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 10/14/2018

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 12/24/2020

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 12/30/2020

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 5/7/2021

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.


Changed on 5/14/2021

VAERS ID: 287915 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2007-08-02
Onset:2007-08-06
Submitted:2007-08-13
Entered:2007-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B079BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B20510B / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Preterm Birth HX: mother required 1 mo hospitalization prior to birth & had uterine rupture during delivery. Seen on weekly basis by pcp & HH nurse. Had no signs of illness prior to death.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 8/6/07 presumed SIDS, autopsy pending. 8/23/07 Received prelim autopsy report from coroner. COD is pending. Patient was 34 wk preemie twin. Mother had been hospitalized x 1 mo prior to delivery for uterine rupture. Patient was on home monitor. Found lying on side co-sleeping w/twin in crib. 10/5/07 Reviewed autopsy report which states COD as SIDS with prone sleeping position; twin gestation & manner of death as natural. Pathologic dx include: premature birth (34 wk), mild right ventricular dilatation and pulmonary edema.

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