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This is VAERS ID 309426

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 309426
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45893 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 12/8/2009

VAERS ID: 309426 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45893 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 3/2/2010

VAERS ID: 309426 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45893 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 4/7/2010

VAERS ID: 309426 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45893 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 8/31/2010

VAERS ID: 309426 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45893 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 5/13/2013

VAERS ID: 309426 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 4/14/2017

VAERS ID: 309426 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Gliosis, Sudden infant death syndrome, Polymerase chain reaction, Viral test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 9/14/2017

VAERS ID: 309426 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 0 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 0 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 2/14/2018

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 6/14/2018

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 8/14/2018

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 9/14/2018

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 10/14/2018

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 12/24/2020

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 12/30/2020

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 5/7/2021

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.


Changed on 5/14/2021

VAERS ID: 309426 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New York
Vaccinated:2008-04-03
Onset:2008-04-06
Submitted:2008-04-08
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B139AA / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF232AD / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45893 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16640 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-06
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: None
Current Illness: None
Preexisting Conditions: Twin A
Allergies:
Diagnostic Lab Data: All viral PCR tests (-). Drug screen (-). Mass spec shows no underlying metabolic disorder
CDC 'Split Type':

Write-up: Unexplained death/SIDS 6/12/2008 Autopsy received with COD Sudden Infant Death Syndrome. Manner of Death: Natural. Neuropathology report DX: Gliosis of the Medullary Nuclei.

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