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This is VAERS ID 469542

Case Details

VAERS ID: 469542 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: Kentucky  
Vaccinated:2012-09-07
Onset:2012-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2012-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B323AA / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1070AA / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 918242 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0055AE / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-08
   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:
Current Illness: None
Preexisting Conditions: GER
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient expired on 9/08/2012 at 4:00 AM, in her home.


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