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This is VAERS ID 465858

Case Details

VAERS ID: 465858 (history)  
Form: Version 1.0  
Age: 0.62  
Sex: Female  
Location: North Carolina  
Vaccinated:2012-08-28
Onset:2012-08-30
   Days after vaccination:2
Submitted: 2012-09-14
   Days after onset:15
Entered: 2012-09-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Apnoeic attack, Autopsy, Brain death, Cyanosis, Death, Hypoxic-ischaemic encephalopathy, Intensive care, Multi-organ failure, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sepsis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-02
   Days after onset: 3
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC Split Type:

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


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