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This is VAERS ID 481268

Case Details

VAERS ID: 481268 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Female  
Location: Florida  
Vaccinated:2013-01-10
Onset:2013-01-11
   Days after vaccination:1
Submitted: 2013-01-14
   Days after onset:3
Entered: 2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 1 MO / PO

Administered by: Unknown       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-01-11
   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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: None.


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