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This is VAERS ID 489865

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2013

VAERS ID: 489865
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 6/14/2014

VAERS ID: 489865 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 3/14/2015

VAERS ID: 489865 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 2/14/2017

VAERS ID: 489865 Before After
VAERS Form:
Age:0.2 0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 9/14/2017

VAERS ID: 489865 Before After
VAERS Form:(blank) 1
Age:0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 1 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 2/14/2018

VAERS ID: 489865 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 6/14/2018

VAERS ID: 489865 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 8/14/2018

VAERS ID: 489865 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 9/14/2018

VAERS ID: 489865 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.


Changed on 10/14/2018

VAERS ID: 489865 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Tennessee
Vaccinated:2013-04-22
Onset:2013-04-23
Submitted:2013-04-23
Entered:2013-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4360AA / 2 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHHVC188CA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G57197 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H012974 / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Crying, Hypotonia, Respiratory arrest, Resuscitation, Skin discolouration, Unresponsive to stimuli, Lip disorder, Respiratory tract congestion, Eye movement disorder, Breath sounds abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-04-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac 15mg/ 1ml 1 ml BID
Current Illness:
Preexisting Conditions: Jaundice, GERD.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 9:02 am mother called and was worried about pt''s lip doing a funny thing, immediately spoke to mother concerning pt, and stated that pt''s lip had been doing something funny and had been crying and sounded a little congested and rattling, but had received shots yesterday and been put on Zantac for reflux, pt''s eyes had not been moving, but now were closed she thought she was tired from crying, noticed earlier that her forehead looked purple but better now and her buttocks looked a little purple but didn''t know why, stated her lip was getting better now, but her brother had tried saying her names but pt. did not focus her eyes on him just looked straight ahead, asked if pt was having distressed breathing and mom stated no, breathing fine, advised mom to bring pt. now to see Dr. and have pt looked at, ask pt. again if pt was having any distressed breathing, mom stated no, mother called back after getting off the phone with her at approximately 9:05am, mom called back 2 approximately 2 minutes after hanging up with her and told me that baby was not breathing and limp, advised to call 911 and told me she had, told her to start CPR, mom stated already had started CPR, wanted to know how many compressions, told mom 15 compressions with 2 breaths, advised papaw was doing breaths and she was doing compressions, advised to keep doing CPR till ambulance arrived, mom stated looked like the stomach was rising, keep doing CPR don''t stop, ask her to check for pulse, explained to where to check for pulse on infant, brachial pulse, but stated she was trying but couldn''t feel anything, advised keep doing CPR, don''t stop, the nurses here again called for an ambulance and told us they were 2 in route but didn''t know where they were located at, advised keep doing CPR, mom stated thought she heard some gargling, Dr took over phone call.

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