National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/12/2021 release of VAERS data:

This is VAERS ID 415725

Government Disclaimer on use of this data



Case Details

VAERS ID: 415725 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: Indiana  
Vaccinated:2011-01-13
Onset:2011-01-16
   Days after vaccination:3
Submitted: 2011-01-21
   Days after onset:5
Entered: 2011-01-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3748AB / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB833CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0526Z / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Autopsy, Death, Respiratory arrest, Sudden infant death syndrome, Toxicologic test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-01-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Clubfoot; tongue-tie
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received vaccinations at at 10:00am on 1-13-11 - no problems noted after receiving vaccinations. Infant found not breathing at 0930 on 1-16-11 by parents. Had been sleeping in car seat (not strapped in)- in living room. Unable to resuscitate. Pronounced dead at hospital. Autopsy listed cause of death SUIDS - Sudden Unexplained infant death. Awaiting toxicology reports/results.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=415725


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