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From the 10/15/2021 release of VAERS data:

This is VAERS ID 309368



Case Details

VAERS ID: 309368 (history)  
Form: Version 1.0  
Age: 0.28  
Sex: Female  
Location: Virginia  
Vaccinated:2008-04-07
Onset:2008-04-11
   Days after vaccination:4
Submitted: 2008-04-11
   Days after onset:0
Entered: 2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 1 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Sudden infant death syndrome, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-04-11
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO MEDICATIONS AS OF 04/07/08 WHEN SEEN IN OFFICE FOR 2 MONTH WELL CHILD CHECK
Current Illness: NO NOTED ILLNESS WHEN EXAMINED AT 2 MONTH WELL CHILD CHECK ON 04/07/08
Preexisting Conditions: PREMATURE- 32 WEEK GESTATION DUE TO PLACENTAL ABRUPTION. DIAGNOSIS WHILE IN NICU: RESPIRATORY DISTRESS SYNDROME; HYPOTENSION; INTRAVENTRICULAR HEMORRHAGE GRADE 1; DIFFICULT INTRAVENOUS ACCESS; RULE OUT SEPSIS; HYPERBILIRUBINEMIA- INDIRECT; POSSIBLE MATERNAL DRUG USE; FEEDING INTOLERANCE. DISCHARGED FROM NICU ON 01/14/08 AND FOLLOWED UP IN OFFICE ON 01/16/08 FOR WEIGHT AND FEED CHECK- NOTED TO BE GAINING WEIGHT AND FEEDING WELL. SEEN IN OFFICE ON 02/02/08 FOR RECHECK WEIGHT, CONGESTION- NASAL, SLIGHT COUGH, AND SNEEZING. SEEN IN ER ON 02/02/08 FOR QUESTIONABLE APNEA EPISODE WITH CHOKING. EMS CALLED AND PT TAKEN TO ER FOR EVALUATION. NO S/S OF ILLNESS FOUND AT ER VISIT. WHEN SEEN IN OUR OFFICE ON 02/05/08 DIAGNOSED WITH COMMON COLD AND GASTROESOPHOGEAL REFLUX. THEN NOT SEEN AGAIN UNTIL 04/07/08 WHEN SHE WAS GIVEN A 2 MONTH WELL CHILD CHECK AND IMMUNIZATIONS. SHE WAS FOUND AT THAT VISIT TO BE GAINING AND GROWING WELL AND DEVELOPING NORMALLY FOR ADJUSTED AGE FOR PREMATURITY. PMH; c-section secondary to placental abruption, in hospital x 3 wks for respiratory problems.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ON 04/07/08, THE 2 MONTH IMMUNIZATIONS OF PEDIARIX, PREVNAR, ACT HIB AND ROTATEQ WERE ADMINISTERED TO THIS PATIENT AT HER CURRENT AGE OF 3 1/2 MONTHS. THERE WERE NO ADVERSE EFFECTS NOTED WHILE IN THE OFFICE. THERE WERE NO PHONE CALLS FROM PARENTS REPORTING PROBLEMS AFTER LEAVING THE OFFICE. MEDICAL EXAMINER CALLED THIS MORNING (04/11/08) TO MAKE DR. AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESCUSITATE THE INFANT. CASE IS BEING INVESTIGATED BY COUNTY SHERIFF''S OFFICE AND IS MEDICAL EXAMINER''S CASE. AUTOPSY WILL BE DONE. AT PRESENT THE PRESUMED DIAGNOSIS IS SUDDEN INFANT DEATH SYNDROME. 6/27/08 Autopsy states COD as sudden unexplained infant death assoc w/prior sibling death, non-standard bedding & prematurity. Autopsy states no evidence of trauma, disease or congenital anomaly.


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