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This is VAERS ID 288181

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288181
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asphyxia, Death, Injury, Unresponsive to stimuli, Accidental death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive.


Changed on 12/8/2009

VAERS ID: 288181 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asphyxia, Death, Injury, Unresponsive to stimuli, Accidental death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 3/2/2010

VAERS ID: 288181 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asphyxia, Death, Injury, Unresponsive to stimuli, Accidental death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 4/7/2010

VAERS ID: 288181 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B58845E / 0 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asphyxia, Death, Injury, Unresponsive to stimuli, Accidental death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 8/31/2010

VAERS ID: 288181 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B58845E / 0 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asphyxia, Death, Injury, Unresponsive to stimuli, Accidental death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 5/14/2017

VAERS ID: 288181 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 0 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Asphyxia, Death, Injury, Unresponsive to stimuli, Accidental death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 9/14/2017

VAERS ID: 288181 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 0 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 2/14/2018

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 6/14/2018

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 8/14/2018

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 9/14/2018

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 10/14/2018

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 12/10/2020

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Unknown Texas
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 12/24/2020

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 12/30/2020

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 5/7/2021

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.


Changed on 5/14/2021

VAERS ID: 288181 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:2007-08-03
Onset:2007-08-09
Submitted:2007-08-14
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B114BB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF018AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B58845E / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-09
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: Infant Tylenol
Current Illness: NONE
Preexisting Conditions: UMBILICAL HERNIA UNDERWEIGHT
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found August 9,2007 in between both parents unresponsive. 8/17/07 Received call from provider, will not send vax record but read lot #s to check against report. RO dose & lot # correct as reported; however, 2 other lot #s corrected in VAERS database. 9/25/07 Reviewed Autopsy Report which reveals COD as traumatic asphyxia due to entrapment of head between mattress & headboard. Manner of Death: accident.

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