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This is VAERS ID 464200

Case Details

VAERS ID: 464200 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Iowa  
Vaccinated:2011-07-25
Onset:2011-07-25
   Days after vaccination:0
Submitted: 2012-08-30
   Days after onset:402
Entered: 2012-09-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / UNK MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Decreased appetite, Irritability, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-08-11
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


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