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This is VAERS ID 314113

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 314113
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45891 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had"been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 12/8/2009

VAERS ID: 314113 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45891 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had"been had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 3/2/2010

VAERS ID: 314113 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C45891 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 4/7/2010

VAERS ID: 314113 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C45891 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 8/31/2010

VAERS ID: 314113 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C45891 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 5/13/2013

VAERS ID: 314113 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 4/14/2017

VAERS ID: 314113 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Respiratory tract congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 9/14/2017

VAERS ID: 314113 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 1 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 2/14/2018

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 6/14/2018

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 8/14/2018

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 9/14/2018

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 10/14/2018

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Minnesota
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 12/10/2020

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Minnesota Michigan
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 12/24/2020

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Michigan
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 12/30/2020

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Michigan
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 5/7/2021

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Michigan
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.


Changed on 5/14/2021

VAERS ID: 314113 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Michigan
Vaccinated:2008-05-19
Onset:2008-05-29
Submitted:2008-05-29
Entered:2008-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B156BA / 2 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR U231AB,UF174AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C45891 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0212X / 2 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-05-29
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: CLOTRIMAZOLE 1 % EX CREA
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had immunizations on 5-19-08 and was found in bed on back today. 7/18/2008 Autopsy report received with COD: Sudden Unexplained Infant Death. Report states infant had some chest congestion x 2 days for which no medication used for tx. Infant had been acting normally with no other recent c/o. Infant had fed at 1 am and at 4 am parent noted infant was not breathing.

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