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This is VAERS ID 490225

Case Details

VAERS ID: 490225 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Male  
Location: Arizona  
Vaccinated:2013-03-26
Onset:2013-03-29
   Days after vaccination:3
Submitted: 2013-04-25
   Days after onset:27
Entered: 2013-04-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Death, Resuscitation, 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: 2013-03-29
   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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


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