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This is VAERS ID 465936

Case Details

VAERS ID: 465936 (history)  
Form: Version 1.0  
Age: 0.21  
Sex: Female  
Location: Florida  
Vaccinated:2011-12-14
Onset:2011-12-17
   Days after vaccination:3
Submitted: 2012-09-22
   Days after onset:279
Entered: 2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 1 MO / PO

Administered by: Unknown       Purchased by: Other
Symptoms: Autopsy, Death, Musculoskeletal stiffness, Respiratory arrest, Resuscitation, Sudden infant death syndrome
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Neonatal disorders (narrow), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2011-12-17
   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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


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