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This is VAERS ID 307764

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 307764
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145E / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pl"eurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congest


Changed on 12/8/2009

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145E / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pl"eurae pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congest congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 3/2/2010

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B70145E / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 4/7/2010

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B70145E / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 8/31/2010

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B70145E / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 5/13/2013

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 6/14/2014

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 2/14/2017

VAERS ID: 307764 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Nasopharyngitis, Otitis media, Petechiae, Pulmonary oedema, Sudden infant death syndrome, Unresponsive to stimuli, Vomiting, Respiratory tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 9/14/2017

VAERS ID: 307764 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 1 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 2/14/2018

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 6/14/2018

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 8/14/2018

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 9/14/2018

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 10/14/2018

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 12/24/2020

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 12/30/2020

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 5/7/2021

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.


Changed on 5/14/2021

VAERS ID: 307764 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:California
Vaccinated:2008-03-10
Onset:2008-03-11
Submitted:2008-03-22
Entered:2008-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2800AA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF233AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0298 / 2 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B70145E / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0110X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-11
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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Medical examiner identified cause of death as SIDS (verbal report to me).
CDC 'Split Type':

Write-up: Patient died of Sudden Infant Death Syndrome the day after receiving DTaP, IPV, HIB, PCV7 and Rotateq. 6/13/08 Autopsy report states COD as SIDS. Report also states slight pulmonary edema & petechial hemorrhages on thymus gland, pericardium of heart & pleurae of lungs. Patient had been placed down for nap on his left side in adult bed at daycare provider. Patient found face down & unresponsive approx 45-50 min later. CPR was started & EMS called. PMH: NSVD, no complications. Upper respiratory congestion frequently since birth & seen for cold s/s by PCP on 3/3. Otitis media 2/1 & had mild wheezing. Sibling w/recent cold symptoms. Had to be picked up early from daycare x2 the week before death due to vomiting.

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