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This is VAERS ID 379725

History of Changes from the VAERS Wayback Machine

First Appeared on 3/2/2010

VAERS ID: 379725
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:0000-00-00
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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:
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 4/7/2010

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:0000-00-00
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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:
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 6/2/2010

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:0000-00-00 2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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:
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 7/31/2010

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 8/31/2010

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 1/4/2011

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 4/13/2011

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 5/13/2011

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 6/11/2011

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 5/13/2013

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 3/14/2015

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Spina bifida occulta, Sudden death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 2/14/2017

VAERS ID: 379725 Before After
VAERS Form:
Age:0.2 0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 9/14/2017

VAERS ID: 379725 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 0 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / - UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 2/14/2018

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 6/14/2018

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 8/14/2018

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 9/14/2018

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 10/14/2018

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 12/24/2020

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.


Changed on 12/30/2020

VAERS ID: 379725 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:Virginia
Vaccinated:2010-01-08
Onset:2010-01-12
Submitted:2010-02-08
Entered:2010-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3433AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHAVB359AA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0181Y / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-12
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: None
Allergies:
Diagnostic Lab Data: SIDS 1/12/09
CDC 'Split Type':

Write-up: Child given PENTACEL, ROTATEQ, and ENGERIX on 1/8/09. Child with apparent SIDS 1/12/09. I am not sure what the final ME report stated.

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