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This is VAERS ID 463731

Case Details

VAERS ID: 463731 (history)  
Form: Version 1.0  
Age: 0.35  
Sex: Male  
Location: New Hampshire  
Vaccinated:2012-07-11
Onset:2012-08-25
   Days after vaccination:45
Submitted: 2012-08-31
   Days after onset:6
Entered: 2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-08-25
   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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC Split Type: NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


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