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This is VAERS ID 309368

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 309368
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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 AT UVA: RESPIRATORY DISTRESS SYNDROME; HYPOTENSION; INTRAVENTRICULAR HEMORRHAGE GRADE 1; DIFFICULT INTRAVENOUS ACCESS; RULE OUT SEPSIS; HYPERBILIRUBINEMIA- I
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 REPORTI"NG PROBLEMS AFTER LEAVING THE OFFICE. DR. SAYRE, MEDICAL EXAMINER FROM ROCKBRIDGE COUNTY, CALLED THIS MORNING (04/11/08) TO MAKE DR. PINKSTON AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESUSITATE THE


Changed on 12/8/2009

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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 AT UVA: RESPIRATORY DISTRESS SYNDROME; HYPOTENSION; INTRAVENTRICULAR HEMORRHAGE GRADE 1; DIFFICULT INTRAVENOUS ACCESS; RULE OUT SEPSIS; HYPERBILIRUBINEMIA- I INDIRECT; POSSIBLE MATERNAL DRUG USE; FEEDING INTOLERANCE. DISCHARGED FROM UVA NICU ON 01/14/08 AND FOLLOWED UP IN OFFICE ON 01/16/08 FOR WEIGHT
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 REPORTI"NG REPORTING PROBLEMS AFTER LEAVING THE OFFICE. DR. SAYRE, MEDICAL EXAMINER FROM ROCKBRIDGE COUNTY, CALLED THIS MORNING (04/11/08) TO MAKE DR. PINKSTON AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESUSITATE THE INFANT. CASE IS BEING INVESTIGATED BY COUNTY SHERIFF''S OFFICE AND IS MEDICAL EXAMINER''S CASE. AUTOPSY WILL BE DONE IN ROANOKE. 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.


Changed on 3/2/2010

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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 AT UVA: RESPIRATORY DISTRESS SYNDROME; HYPOTENSION; INTRAVENTRICULAR HEMORRHAGE GRADE 1; DIFFICULT INTRAVENOUS ACCESS; RULE OUT SEPSIS; HYPERBILIRUBINEMIA- INDIRECT; POSSIBLE MATERNAL DRUG USE; FEEDING INTOLERANCE. DISCHARGED FROM UVA NICU ON 01/14/08 AND FOLLOWED UP IN OFFICE ON 01/16/08 FOR WEIGHT
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. DR. SAYRE, MEDICAL EXAMINER FROM ROCKBRIDGE COUNTY, CALLED THIS MORNING (04/11/08) TO MAKE DR. PINKSTON AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESUSITATE THE INFANT. CASE IS BEING INVESTIGATED BY COUNTY SHERIFF''S OFFICE AND IS MEDICAL EXAMINER''S CASE. AUTOPSY WILL BE DONE IN ROANOKE. 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.


Changed on 4/7/2010

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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 AT UVA: RESPIRATORY DISTRESS SYNDROME; HYPOTENSION; INTRAVENTRICULAR HEMORRHAGE GRADE 1; DIFFICULT INTRAVENOUS ACCESS; RULE OUT SEPSIS; HYPERBILIRUBINEMIA- INDIRECT; POSSIBLE MATERNAL DRUG USE; FEEDING INTOLERANCE. DISCHARGED FROM UVA NICU ON 01/14/08 AND FOLLOWED UP IN OFFICE ON 01/16/08 FOR WEIGHT
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. DR. SAYRE, MEDICAL EXAMINER FROM ROCKBRIDGE COUNTY, CALLED THIS MORNING (04/11/08) TO MAKE DR. PINKSTON AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESUSITATE THE INFANT. CASE IS BEING INVESTIGATED BY COUNTY SHERIFF''S OFFICE AND IS MEDICAL EXAMINER''S CASE. AUTOPSY WILL BE DONE IN ROANOKE. 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.


Changed on 8/31/2010

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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 AT UVA: RESPIRATORY DISTRESS SYNDROME; HYPOTENSION; INTRAVENTRICULAR HEMORRHAGE GRADE 1; DIFFICULT INTRAVENOUS ACCESS; RULE OUT SEPSIS; HYPERBILIRUBINEMIA- INDIRECT; POSSIBLE MATERNAL DRUG USE; FEEDING INTOLERANCE. DISCHARGED FROM UVA NICU ON 01/14/08 AND FOLLOWED UP IN OFFICE ON 01/16/08 FOR WEIGHT
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. DR. SAYRE, MEDICAL EXAMINER FROM ROCKBRIDGE COUNTY, CALLED THIS MORNING (04/11/08) TO MAKE DR. PINKSTON AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESUSITATE THE INFANT. CASE IS BEING INVESTIGATED BY COUNTY SHERIFF''S OFFICE AND IS MEDICAL EXAMINER''S CASE. AUTOPSY WILL BE DONE IN ROANOKE. 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.


Changed on 7/13/2012

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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 AT UVA: 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 UVA 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
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. DR. SAYRE, MEDICAL EXAMINER FROM ROCKBRIDGE COUNTY, CALLED THIS MORNING (04/11/08) TO MAKE DR. PINKSTON AWARE THAT PATIENT HAD BEEN FOUND UNRESPONSIVE ON MORNING OF 4/11/08. RESCUE SQUAD WAS UNABLE TO RESUSITATE RESCUSITATE THE INFANT. CASE IS BEING INVESTIGATED BY COUNTY SHERIFF''S OFFICE AND IS MEDICAL EXAMINER''S CASE. AUTOPSY WILL BE DONE IN ROANOKE. 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.


Changed on 5/13/2013

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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
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.


Changed on 6/14/2014

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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
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.


Changed on 2/14/2017

VAERS ID: 309368 Before After
VAERS Form:
Age:0.3 0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
Entered:2008-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF219AA/UF154AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45894 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1195U / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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:
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
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.


Changed on 4/14/2017

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

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Death of relative, Premature baby, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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
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.


Changed on 9/14/2017

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

Administered by: Unknown      Purchased by: Unknown
Symptoms: Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 2/14/2018

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 6/14/2018

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 8/14/2018

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 9/14/2018

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 10/14/2018

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 12/24/2020

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 12/30/2020

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 5/7/2021

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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.


Changed on 5/14/2021

VAERS ID: 309368 Before After
VAERS Form:1
Age:0.28
Sex:Female
Location:Virginia
Vaccinated:2008-04-07
Onset:2008-04-11
Submitted:2008-04-11
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-11
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: 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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