National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 311463

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 311463
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral su"rfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 12/8/2009

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral su"rfaces surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 3/2/2010

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 4/7/2010

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 5/11/2010

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 8/31/2010

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 4/13/2011

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 5/13/2011

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 6/11/2011

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 5/13/2013

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 6/14/2014

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 4/14/2017

VAERS ID: 311463 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Sudden infant death syndrome, Unresponsive to stimuli, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 9/14/2017

VAERS ID: 311463 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 2 3 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 2/14/2018

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 6/14/2018

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 8/14/2018

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 9/14/2018

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 10/14/2018

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 12/24/2020

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 12/30/2020

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 5/7/2021

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.


Changed on 5/14/2021

VAERS ID: 311463 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Idaho
Vaccinated:2008-03-31
Onset:2008-04-24
Submitted:2008-04-29
Entered:2008-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B138BA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08702C / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0509U / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-04-24
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This child had his last set of immunizations on 3-31-08. He did not have any reactions. He died of SIDS on 4-24-08. 6/13 Autopsy report states COD as sudden unexplained death in infancy. Report also states patient had petechiae of thymus & visceral surfaces of lungs; no evidence of injury; normal growth parameters; neg metabolic screen; no evidence of aspiration. Had been placed in crib on back w/propped bottle. Found unresponsive.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=311463&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166