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This is VAERS ID 472319

Case Details

VAERS ID: 472319 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Female  
Location: Washington  
Vaccinated:2012-10-25
Onset:2012-10-27
   Days after vaccination:2
Submitted: 2012-10-31
   Days after onset:4
Entered: 2012-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4204AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0058AE / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-10-27
   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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: SIDS.


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