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This is VAERS ID 421094

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 421094
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 6/11/2011

VAERS ID: 421094 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Cyanosis, Death, Heart sounds abnormal, Hypokinesia, Pulse absent, Respiratory arrest, Resuscitation, Vomiting, Skin turgor decreased, Endotracheal intubation, Capillary nail refill test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 8/12/2011

VAERS ID: 421094 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Cyanosis, Death, Heart sounds abnormal, Hypokinesia, Pulse absent, Respiratory arrest, Resuscitation, Vomiting, Skin turgor decreased, Endotracheal intubation, Capillary nail refill test abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 5/13/2013

VAERS ID: 421094 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 6/14/2014

VAERS ID: 421094 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 2/14/2017

VAERS ID: 421094 Before After
VAERS Form:
Age:0.2 0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 4/14/2017

VAERS ID: 421094 Before After
VAERS Form:
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 9/14/2017

VAERS ID: 421094 Before After
VAERS Form:(blank) 1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 2/14/2018

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 6/14/2018

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 8/14/2018

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 9/14/2018

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 10/14/2018

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 12/24/2020

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 12/30/2020

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 5/7/2021

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.


Changed on 5/14/2021

VAERS ID: 421094 Before After
VAERS Form:1
Age:0.19
Sex:Female
Location:New Hampshire
Vaccinated:2011-02-01
Onset:2011-03-03
Submitted:2011-03-03
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3613AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB977AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915192 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0948Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-03
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: Acyclovir at birth 25 mg IV Q 6 Hrs.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH04151101

Write-up: Mother had + HSV, gestational diabetes and protein S deficiency.

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