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This is VAERS ID 127161

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 127161
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2958AZ / 0 LL / -
IPV: POLIOVAX / CONNAUGHT LTD P01263 / 0 LL / -
RV: ROTASHIELD / WYETH 4988133 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, APNEA, COMA, ENCEPHALOPATHY, ANOMALY GI

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type': s/p duodenal atresia repair; s/p lysis of adhesions

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 12/8/2009

VAERS ID: 127161 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-17 1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2958AZ / 0 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. P01263 / 0 LL / -
RV: ROTASHIELD ROTAVIRUS (ROTASHIELD) / WYETH WYETH PHARMACEUTICALS, INC 4988133 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation, AGITATION, APNEA, COMA, ENCEPHALOPATHY, ANOMALY GI

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type': s/p duodenal atresia repair; s/p lysis of adhesions (blank)

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 8/31/2010

VAERS ID: 127161 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 0 LL / -
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 4988133 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 5/14/2017

VAERS ID: 127161 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 0 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 9/14/2017

VAERS ID: 127161 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 0 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 0 1 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 2/14/2018

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 6/14/2018

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 8/14/2018

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 9/14/2018

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 10/14/2018

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 12/24/2020

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 12/30/2020

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 5/7/2021

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;


Changed on 5/21/2021

VAERS ID: 127161 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:California
Vaccinated:1999-07-12
Onset:1999-07-14
Submitted:1999-08-05
Entered:1999-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2958AZ / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P01263 / 1 LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 4988133 / 1 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Coma, Encephalopathy, Gastrointestinal disorder, Ileus, Intestinal obstruction, Large intestine perforation, Lung disorder, Mesenteric occlusion, Pallor, Pneumonia, Respiratory disorder, Sepsis, Shock, Gastrointestinal malformation

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1999-07-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: none known~ ()~~~In patient
Other Medications: dtap & hib 6/1/99
Current Illness: none
Preexisting Conditions: s/p duodenal atresia repair; s/p lysis of adhesions
Allergies:
Diagnostic Lab Data: disrupted cecum, abd fall of bowel contents; mesentery thrombosed; much of bowel ischemic;post mortem exam, final results pending;
CDC 'Split Type':

Write-up: 2day p/vax 5:30pm unusual cry; pallor, taken to ER; mom suspected bowel obstruction; xray showed ileus; 7:30pm cardiac arrest: resuscitation/unconscious; sent to UCSF; 7/15 remained unstable,no possibility of surgery as result;pt died 7/15;

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