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This is VAERS ID 307188

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307188
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
DTIPV: DT + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER AC21B141AA / 0 RL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC B97283A / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evevings. He was taken to the docto
Preexisting Conditions: Patient experianced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All reults were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given tylenol at the dr''''s instrucions and slept most of Monday evening other than waking"to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:3


Changed on 12/8/2009

VAERS ID: 307188 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
DTIPV: DT + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER AC21B141AA / 0 RL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC B97283A / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evevings. He was taken to the docto
Preexisting Conditions: Patient experianced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All reults were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given tylenol at the dr''''s dr''s instrucions and slept most of Monday evening other than waking"to waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:3 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 8/31/2010

VAERS ID: 307188 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
DTIPV: DT + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER AC21B141AA / 0 RL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B97283A / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evevings. He was taken to the docto
Preexisting Conditions: Patient experianced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All reults were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given tylenol at the dr''s instrucions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 7/13/2012

VAERS ID: 307188 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
DTIPV: DT + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER AC21B141AA / 0 RL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evevings. evenings. He was taken to the docto doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experianced experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All reults results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given tylenol Tylenol at the dr''s instrucions instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 5/13/2013

VAERS ID: 307188 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 0 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 6/14/2014

VAERS ID: 307188 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 2/14/2017

VAERS ID: 307188 Before After
VAERS Form:
Age:0.2 0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 4/14/2017

VAERS ID: 307188 Before After
VAERS Form:
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 0 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Cardio-respiratory arrest, Death, Hyperventilation, Irritability, Resuscitation, Somnolence, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 9/14/2017

VAERS ID: 307188 Before After
VAERS Form:(blank) 1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 0 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 0 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 0 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 2/14/2018

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 6/14/2018

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 8/14/2018

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 9/14/2018

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 10/14/2018

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 12/24/2020

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 12/30/2020

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 5/7/2021

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.


Changed on 5/14/2021

VAERS ID: 307188 Before After
VAERS Form:1
Age:0.21
Sex:Male
Location:Texas
Vaccinated:2008-03-03
Onset:2008-03-05
Submitted:2008-03-17
Entered:2008-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B141AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 6F231AA / 1 LL / UN
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH B97283A / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1664U / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Death, Hyperventilation, Irritability, Resuscitation, Somnolence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIDIFIER, OCEAN SPRAY NASAL MIST
Current Illness: Patient had a stuffy nose that caused him to have trouble breathing through his nose in the evenings. He was taken to the doctor on several occasions because of this. We were worried he could possibly have a cold or the flu or maybe a sinus infection.
Preexisting Conditions: Patient experienced some grunting after birth. The hospital performed blood tests on him and checked his lungs for any abnormalities. All results were negative for any infections.
Allergies:
Diagnostic Lab Data: An autopsy is currently being done to find out the cause of death. 6/3/08-records received: cause of death-Sudden Infant Death Syndrome. Natural causes.
CDC 'Split Type':

Write-up: Patient was given the following vaccines: Hep B, HIB, Rotateq, DT/DTAP, IPV, Pneumococcal Conj. on Monday March 3rd, 2008 around 1:45pm. He was fussy after and was given Tylenol at the dr''s instructions and slept most of Monday evening other than waking to eat. Tuesday he was still taking deap breaths as if he just finished crying and was very quiet. Although I still was able to have him coo with me he was very calm and relaxed. Monday morning I got him ready for daycare and dropped him off around 7:30 along with his sister and received a phone call at 4:45 that my baby was lot breathing. Daycare performed CPR until the EMS arrived, then the EMS took over and transferred him to the hospital. At the hospital they tried to revive him for an hour and had to pronounce him dead. 3/31/08-records received from ED for DOS 3/5/08-Presented in cardiopulmonary arrest. Found nonresponsive at daycare. Intubated. No blood pressure, no pulse, asystolic pulse. Patient expired. DX: Cardiopulmonary arrest.

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