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This is VAERS ID 289148

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 289148
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690K / 0 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Patent ductus arteriosus, Petechiae, Pulmonary congestion, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS


Changed on 12/8/2009

VAERS ID: 289148 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690K / 0 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Patent ductus arteriosus, Petechiae, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 3/2/2010

VAERS ID: 289148 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08690K / 0 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Patent ductus arteriosus, Petechiae, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 4/7/2010

VAERS ID: 289148 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08690K / 0 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Patent ductus arteriosus, Petechiae, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 8/31/2010

VAERS ID: 289148 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08690K / 0 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Patent ductus arteriosus, Petechiae, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 5/14/2017

VAERS ID: 289148 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 0 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Patent ductus arteriosus, Petechiae, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 9/14/2017

VAERS ID: 289148 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 0 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 0 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 0 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 2/14/2018

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 6/14/2018

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 8/14/2018

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 9/14/2018

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 10/14/2018

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 12/24/2020

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 12/30/2020

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 5/7/2021

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.


Changed on 5/14/2021

VAERS ID: 289148 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Alabama
Vaccinated:2007-08-01
Onset:2007-08-02
Submitted:2007-08-28
Entered:2007-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B129AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF117AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08690K / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-08-02
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 12 hr after receiving the vaccine-baby found dead in hotel bed next to his mother Autopsy Dx: SIDS. 8/31/07 Received vax record from pcp which confirm dose & lot as reported. 1/15/08 Reviewed autopsy report which states COD as Undetermined. Found dead in bed. Findings at autopsy included: SIDS; petechial hemorrhages of thymus & pleura; pulmonary edema & congestion; cerebral edema; & patent ductus arteriosus.

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