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This is VAERS ID 288921

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288921
VAERS Form:
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510B / 2 RL / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Encephalitis, Enterovirus infection, Gliosis, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached


Changed on 12/8/2009

VAERS ID: 288921 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510B / 2 RL / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Death, Encephalitis, Enterovirus infection, Gliosis, Subarachnoid haemorrhage, Subdural haematoma, Brain oedema, Poliomyelitis post vaccine

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 3/2/2010

VAERS ID: 288921 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B26510B / 2 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Encephalitis, Enterovirus infection, Gliosis, Subarachnoid haemorrhage, Subdural haematoma, Brain oedema, Poliomyelitis post vaccine

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 4/7/2010

VAERS ID: 288921 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B26510B / 2 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Encephalitis, Enterovirus infection, Gliosis, Subarachnoid haemorrhage, Subdural haematoma, Brain oedema, Poliomyelitis post vaccine

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 8/31/2010

VAERS ID: 288921 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B26510B / 2 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Encephalitis, Enterovirus infection, Gliosis, Subarachnoid haemorrhage, Subdural haematoma, Brain oedema, Poliomyelitis post vaccine

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 5/14/2017

VAERS ID: 288921 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 2 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death, Encephalitis, Enterovirus infection, Gliosis, Subarachnoid haemorrhage, Subdural haematoma, Brain oedema, Poliomyelitis post vaccine

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 9/14/2017

VAERS ID: 288921 Before After
VAERS Form:(blank) 1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 2 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 2 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 2/14/2018

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 6/14/2018

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 8/14/2018

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 9/14/2018

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 10/14/2018

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 12/24/2020

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 12/30/2020

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 5/7/2021

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.


Changed on 5/14/2021

VAERS ID: 288921 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Iowa
Vaccinated:2007-08-21
Onset:2007-08-23
Submitted:2007-08-24
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B127AA / 3 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B26510B / 3 RL / IM

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-23
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 - had been in ER 8/1 + 8/2 for pharyngitis + upper resp infection
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: See ER notes attached
CDC 'Split Type':

Write-up: See ER notes attached. 11/27/07 Reviewed autopsy report which states COD as encephalomyelitis due to enterovirus (EV 71) & manner of death as natural. States history as: found supine in crib, unresponsive; no recent illness; no previous medical history;brain swelling; SDH, minimal; SAH, bilateral; microglial clusters, neuronal loss, neuronophagia & mild perivascular lymphocytic infiltrate w/gliosis in keeping with a viral poliomyelitis.

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