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This is VAERS ID 487601

Case Details

VAERS ID: 487601 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: Iowa  
Vaccinated:2013-03-20
Onset:2013-03-21
   Days after vaccination:1
Submitted: 2013-03-22
   Days after onset:1
Entered: 2013-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4335AA / 2 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH774AB / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1604 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F42899 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012979 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-03-21
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Maternal smoker - 1.5 ppd
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child was found unresponsive in crib on 3/21/13 am. Mom had fed at approx. 3 am and baby was fine. Found at 7 am face down in bassinet. 911 called. Pronounced dead at hospital.


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