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This is VAERS ID 259249

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 259249
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. Y1050 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respir"atory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06.


Changed on 12/8/2009

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respir"atory respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 3/2/2010

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 4/7/2010

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 8/31/2010

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 4/13/2011

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 5/13/2011

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 6/11/2011

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 2/14/2017

VAERS ID: 259249 Before After
VAERS Form:
Age:0.4 0.36
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 5/14/2017

VAERS ID: 259249 Before After
VAERS Form:
Age:0.36
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UE650AB / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR Y1050 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08653F / 1 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


Changed on 9/14/2017

VAERS ID: 259249 Before After
VAERS Form:(blank) 1
Age:0.36
Gender:Male
Location:Alabama
Vaccinated:2006-06-21
Onset:2006-06-24
Submitted:2006-07-03
Entered:2006-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B027AA / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE650AB / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR Y1050 / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08653F / 1 2 RL / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaemia, Condition aggravated, Cor pulmonale, Eczema, Hypoglycaemia neonatal, Hypoxia, Lung disorder, Patent ductus arteriosus, Pneumonia, Respiratory distress, Sepsis, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Diuril, Aldactone, CA supplements
Current Illness: Cystic Bronchopulmonary Dysplasia
Preexisting Conditions: Bronchpulmonary dysplasia (extreme prematurity)
Allergies:
Diagnostic Lab Data: Blood Culture, CSF, Urine culture from 06/23/06 = negative Liver enlargement by US along with elevated total and direct bilirubin. US of brain revelaed right occipital lobe ischemia./ss
CDC 'Split Type':

Write-up:Patient received 4 mo vaccine; 24hrs post vaccine was given, pt has progressively needed increased oxygen requirements related to desaturations. Septic workup done and antibiotic therapy started. Within 72hrs, pt was retintubated on 06/24/06 due to respiratory distress. All cultures were negative, antibiotics stopped after 3 days. Pt improved and was extubated on 06/26/06. 10/13/2006 Received medical records which reveal patient was hospitalized from birth 2/12/06 until d/c to home 9/27/06. Hospitalization included multiple probable episodes of sepsis, treated with antibiotics, multiple episodes of hypoglycemia and pneumonia. Trached. Eczema. Received multiple blood transfusions for anemia, and platelet transfusions for thrombocytopenia. Large PDA treated with fluid restriction. Multiple episodes of coding. Final Active Dx: bronchopulmonary dysplasia, cor pulmonale./ss


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