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This is VAERS ID 483614

Case Details

VAERS ID: 483614 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: South Carolina  
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted: 2013-01-31
Entered: 2013-02-07
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


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