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This is VAERS ID 466002

Case Details

VAERS ID: 466002 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Utah  
Vaccinated:2012-06-25
Onset:2012-06-26
   Days after vaccination:1
Submitted: 2012-07-19
   Days after onset:23
Entered: 2012-09-24
   Days after submission:67
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B305 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0254AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F89912 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0677AA / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Autopsy, Death, Toxicologic test
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-06-26
   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: Dexamethasone 2mg
Current Illness: Viral Croup
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Toxicology pending / autopsy results pending
CDC Split Type:

Write-up: Patient seen in office for well child check, normal healthy child with viral symptoms. Immunizations performed, child tolerated well. Following morning found deceased.


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