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This is VAERS ID 337670

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 337670
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 3/2/2010

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 4/7/2010

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 8/31/2010

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 4/13/2011

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 5/13/2011

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 6/11/2011

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 5/13/2013

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 6/14/2014

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 2/14/2017

VAERS ID: 337670 Before After
VAERS Form:
Age:0.1 0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: None
Preexisting Conditions: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 4/14/2017

VAERS ID: 337670 Before After
VAERS Form:
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Patent ductus arteriosus, Pulmonary congestion, Pulmonary oedema, Respiratory arrest, Sudden infant death syndrome, Brain oedema, Autopsy, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 9/14/2017

VAERS ID: 337670 Before After
VAERS Form:(blank) 1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 2/14/2018

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 6/14/2018

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 8/14/2018

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 9/14/2018

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 10/14/2018

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 12/24/2020

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 12/30/2020

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 5/7/2021

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.


Changed on 5/21/2021

VAERS ID: 337670 Before After
VAERS Form:1
Age:0.13
Sex:Male
Location:Alabama
Vaccinated:2009-01-08
Onset:2009-01-10
Submitted:2009-01-12
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B77CA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF496AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05882 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1358X / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-10
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: Heart murmur
Allergies:
Diagnostic Lab Data: Autopsy pending
CDC 'Split Type':

Write-up: Found by father not breathing approximately 0500 on 1/10. Attempted resuscitation at home via police then EMS. To hospital with resuscitation efforts for approximately 1 hr with no results.

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