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From the 1/14/2022 release of VAERS data:

Found 301 cases where Vaccine is RV1 and Patient Died

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Case Details

This is page 4 out of 31

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VAERS ID: 495685 (history)  
Form: Version 1.0  
Age: 0.25  
Sex: Female  
Location: New Hampshire  
Vaccinated:2013-04-29
Onset:2013-06-03
   Days after vaccination:35
Submitted: 2013-07-02
   Days after onset:29
Entered: 2013-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B412AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH765AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G03533 / 1 LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB344A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-06-03
   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:
Current Illness:
Preexisting Conditions: Hosp x18 d. after birth for withdrawal (mat. use of chronic pain meds)
Allergies:
Diagnostic Lab Data: Autopsy by medical examiner
CDC Split Type: NH07021312

Write-up: Possible SIDS (SUID).


VAERS ID: 498463 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Female  
Location: New Hampshire  
Vaccinated:2013-07-18
Onset:2013-07-18
   Days after vaccination:0
Submitted: 2013-08-05
   Days after onset:18
Entered: 2013-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B412AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR 48739AB / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH G36322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB353A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-07-18
   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:
Current Illness:
Preexisting Conditions: Hx maternal drug use; poor weight gain
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ?SIDS/SUIDS. Death cert. not yet avail. For autopsy report, contact Medical Examiner or HCP.


VAERS ID: 510158 (history)  
Form: Version 1.0  
Age: 0.35  
Sex: Female  
Location: New Hampshire  
Vaccinated:2013-09-20
Onset:2013-10-07
   Days after vaccination:17
Submitted: 2013-10-29
   Days after onset:22
Entered: 2013-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4486AA / UNK UN / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBBC263AA / 3 UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH G47424 / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB358A / UNK UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2013-10-07
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH1029201318

Write-up: SUID / ? SIDS.


VAERS ID: 527097 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: Nebraska  
Vaccinated:2014-03-19
Onset:2014-03-23
   Days after vaccination:4
Submitted: 2014-03-24
   Days after onset:1
Entered: 2014-03-31
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS NJ4N3 / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH943AC / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H00137 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB397A / 2 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-03-23
   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: ZANTAC
Current Illness: None
Preexisting Conditions: Esophageal reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died.


VAERS ID: 533145 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: New Hampshire  
Vaccinated:2014-04-08
Onset:2014-04-21
   Days after vaccination:13
Submitted: 2014-06-06
   Days after onset:46
Entered: 2014-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 9EA47 / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH948AB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H06568 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB8403A / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-04-21
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Medical examiner report pending
CDC Split Type: NH060620149

Write-up: SUID/SIDS.


VAERS ID: 535052 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Male  
Location: Indiana  
Vaccinated:2014-06-13
Onset:2014-06-14
   Days after vaccination:1
Submitted: 2014-06-27
   Days after onset:13
Entered: 2014-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 4M7GD / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR J016188 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H13994 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DB417A / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Adenovirus test positive, Blood culture negative, Cardiac arrest, Cardiac murmur, Cardio-respiratory arrest, Culture urine negative, Death, Electrocardiogram abnormal, Hypotonia, Intensive care, Musculoskeletal stiffness, Nervous system disorder, Nuclear magnetic resonance imaging abnormal, Pyrexia, Respiratory arrest, Resuscitation, Screaming, Staring
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2014-06-20
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Q-var 40 mcg 2 puffs bid; Albuterol prn
Current Illness: Patient with URI symptoms, cough, RN that mom thought was resolving. Afebrile. Later found to have +adenovirus
Preexisting Conditions: 36 week preemie in newborn ICU for several weeks, readmitted to hospital 12/2013 with bronchiolitis and intubated at that time. Diagnosesd with VSD and PFO as newborn
Allergies:
Diagnostic Lab Data: Urine cx NGTD, blood cx NGTD, RVP with +adenovirus. Cardiac - h/o VSD/PFO, systolic murm on exam (baseline), repeat EKG with incomplete RBBB vs RVH, no conduction delay, Non accidental trauma work up negative, MRI 6/19/14 with progressive diffuse ischemia or white matter tracts as compared to priror consistent with global injury
CDC Split Type:

Write-up: Patient had fever of approx 101 on eve of date received vaccines, then had an episode described as eyes staring off and whole body going limp for 5 sec followed by all 4 extremity stiffening that lasted couple of seconds. He then returned to normal with total episode time ~10 sec. He then had another similar episode the following afternoon with return to normal. The eve following receiving vaccination mom heard loud scream from child''s room. She picked up child who was awake, alert. He then had another episode of eyes staring followed by going limp. This time he did not return to baseline and stopped breathing. EMS was called. Patient was in cardiac arrest. Required chest compressions upon arrival to ED. Patient coded for 35 min. To pediatric ICU, vent dependent with severe neurological impairment s/p prolonged cardiopulmonary arrest. Patient was terminally extubated.


VAERS ID: 538748 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Alabama  
Vaccinated:2014-08-01
Onset:2014-08-02
   Days after vaccination:1
Submitted: 2014-08-04
   Days after onset:2
Entered: 2014-08-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS 7537C / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI047AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H45097 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB401A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-08-02
   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: Nystatin
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom reports vomited several times on 8-2-14. States baby was getting diaper change and vomited. States baby went limp. CPR started and ambulance was sent.


VAERS ID: 545049 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: New York  
Vaccinated:2014-08-26
Onset:2014-09-12
   Days after vaccination:17
Submitted: 2014-09-18
   Days after onset:6
Entered: 2014-09-24
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4724AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H65735 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB434A / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Crying, Death, Disseminated intravascular coagulation, Dyspnoea, Enema administration, Food intolerance, Haematochezia, Intussusception, Irritability, Lethargy, Shock, Ultrasound abdomen abnormal
SMQs:, Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-09-15
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hyoscyamine sulfate prescribed 9/12/14
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Abdominal US 9/14/14 confirmed intussusception
CDC Split Type:

Write-up: Fussiness and crying onset 9/12/14 early AM, blood in stool that AM. More lethargic 9/13/14, not tolerating feeds. Seen in Emergency Room 9/13/14 - 9/14/14 - diagnosed with right upper quadrant intussusception reduced with air enema. Symptoms of shock, disseminated intravascular coagulation, third spacing of fluid, difficulty ventilating and ultimate death on 9/15/14.


VAERS ID: 547820 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Female  
Location: Arkansas  
Vaccinated:2014-10-10
Onset:2014-10-11
   Days after vaccination:1
Submitted: 2014-10-14
   Days after onset:3
Entered: 2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS E2297 / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K004540 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH H45100 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB420A / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-10-11
   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:
Current Illness: None noted
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UNKNOWN.


VAERS ID: 550467 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: New Hampshire  
Vaccinated:2014-09-22
Onset:2014-09-27
   Days after vaccination:5
Submitted: 2014-10-28
   Days after onset:31
Entered: 2014-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / UNK UN / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 9423K / UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G65738 / UNK UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A1FB422A / UNK UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2014-09-27
   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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NH1028201414

Write-up: SUID/SIDS.


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