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This is VAERS ID 338821

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 338821
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 3/2/2010

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 4/7/2010

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 8/31/2010

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 1/4/2011

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 4/13/2011

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 5/13/2011

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 6/11/2011

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 2/14/2017

VAERS ID: 338821 Before After
VAERS Form:
Age:1.0 1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood culture positive, Death, Irritability, Pulse absent, Respiratory arrest, Toxicologic test normal, Culture positive, Streptococcus identification test positive

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 9/14/2017

VAERS ID: 338821 Before After
VAERS Form:(blank) 1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / - UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / - UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / - UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / - UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 2/14/2018

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 6/14/2018

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 8/14/2018

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 9/14/2018

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 10/14/2018

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 12/24/2020

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 12/30/2020

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 5/7/2021

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.


Changed on 5/21/2021

VAERS ID: 338821 Before After
VAERS Form:1
Age:1.01
Sex:Female
Location:Washington
Vaccinated:2009-01-21
Onset:2009-01-22
Submitted:2009-02-02
Entered:2009-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB258AA / UNK RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1120X / UNK UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D05879 / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1389X / UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-01-22
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: No concomitant medications were noted in chart by parents. No relevant medical history. No noted adverse events following previous vaccinations. PMH: none
Allergies:
Diagnostic Lab Data: UNK. Labs: Tox screen (-). Blood cx (+) for Strep salivarius (contaminant). Lower respiratory cx (+) for moderate growth of Strep pneumoniae and heavy growth routine resp flora.
CDC 'Split Type': A0766166A

Write-up: This case was reported by a healthcare professional and described the occurrence of death nos in a 12-month-old female subject who was vaccinated with HAVRIX (GlaxoSmithKline), MMR II (strain not specified), VARIVAX and PREVNAR. On 21 January 2009 at 07:43, the subject received unspecified dose of HAVRIX (.5 ml, unknown, right thigh), unspecified dose of MMR II (unknown), unspecified dose of VARIVAX (unknown), and unspecified dose of PREVNAR (unknown). On 22 January 2009, 1 day after vaccination with HAVRIX, after vaccination with MMR II, PREVNAR, and VARIVAX, the subject experienced death nos. The healthcare professional considered the event was disabling, life threatening and clinically significant (or requiring intervention). The subject died on 22 January 2009 from death nos. It was unknown whether an autopsy was performed. It was reported the subject had "no history of illness or medical problems. Not on medications at time of death. Medical examiner stated undetermined cause of death on death certificate". 3/5/09 Autopsy report received with COD: Undetermined. Manner of Death: Undetermined. Child had presented to PCP earlier on the DOD with fever and URI sx. 4 vax given taht day. Child remained cranky and put down to nap. Approx 1 hour later found face down without pulse or respirations. Resuscitation unsuccessful.

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