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This is VAERS ID 307158

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307158
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: ""fussy"" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having /"projectile vomiting and severe diarrhea./" PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''''s mother states /""her pediatrician told her that/"vomiting not due to Rotavirus./" That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states /"she was just fussy the past few days./"


Changed on 12/8/2009

VAERS ID: 307158 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: ""fussy"" "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having /"projectile "projectile vomiting and severe diarrhea./" diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''''s infant''s mother states /""her "her pediatrician told her that/"vomiting that"vomiting not due to Rotavirus./" Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states /"she "she was just fussy the past few days./" days."


Changed on 3/2/2010

VAERS ID: 307158 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54015C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 4/7/2010

VAERS ID: 307158 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54015C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 8/31/2010

VAERS ID: 307158 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54015C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 5/13/2013

VAERS ID: 307158 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 9/14/2017

VAERS ID: 307158 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / - UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 2/14/2018

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 6/14/2018

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 8/14/2018

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 9/14/2018

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 10/14/2018

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 12/24/2020

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 12/30/2020

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 5/7/2021

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."


Changed on 5/14/2021

VAERS ID: 307158 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2008-02-20
Onset:2008-02-26
Submitted:2008-03-14
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B126AA / UNK RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. UF196AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54015C / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1620U / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Diarrhoea, Vomiting projectile

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-12
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: unknown
Current Illness: "fussy" for a few days
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Deceased - unknown
CDC 'Split Type':

Write-up: 1st series of vaccines given 022008. T. Call from mother 022608 states in faint having "projectile vomiting and severe diarrhea." PHN called CDNS who rec. infant see private MD STAT and report to nurse outcome. 022708 call from infant''s mother states "her pediatrician told her that"vomiting not due to Rotavirus." That it is OK to give at 4 months old. 031308 Mom called to say baby dies lat PM. Mom states "she was just fussy the past few days."

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=307158&WAYBACKHISTORY=ON

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