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This is VAERS ID 308717

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308717
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-19
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-"autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 12/8/2009

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-19
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-"autopsy 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 3/2/2010

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-19 2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 4/7/2010

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 8/31/2010

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 1/4/2011

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 4/13/2011

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 5/13/2011

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 6/11/2011

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 5/13/2013

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 2/14/2017

VAERS ID: 308717 Before After
VAERS Form:
Age:0.2 0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 4/14/2017

VAERS ID: 308717 Before After
VAERS Form:
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Hydrocele, Petechiae, Sudden infant death syndrome, Umbilical hernia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 9/14/2017

VAERS ID: 308717 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 2/14/2018

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 6/14/2018

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 8/14/2018

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 9/14/2018

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 10/14/2018

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 12/24/2020

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 12/30/2020

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 5/7/2021

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.


Changed on 5/14/2021

VAERS ID: 308717 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:North Carolina
Vaccinated:2008-03-17
Onset:2008-03-23
Submitted:2008-03-24
Entered:2008-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U2354AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF240AB / 1 LL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0342 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C35172 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1598U / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity (34 weeks), twin 6/20/08-records received-PMH:twin born at 34 weeks, hyperbilirubinemia. Threee episodes of choking in which stopped breathing and turned blue. This occurred at about 2-3 weeks of age.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC08041

Write-up: (Less than 1 week after vaccines ) Death 3/23/08 - found dead in crib 3/23/08 AM by mother. Pronounced dead at the scene. Autopsy pending. Unknown if related to vaccines. 6/20/08-records received-final cause of death:Sudden Infant Death Syndrome. 6/20/08-autopsy report:findings included intrathoracic petechiae, umbilical hernia, tibial subperiosteal new bone formation and right hydrocele.

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