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This is VAERS ID 263520

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 263520
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. UF011AA / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Convulsion, Meningitis, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC"performed in office. Admitted to Hospital


Changed on 12/8/2009

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B047BA / 0 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Convulsion, Meningitis, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC"performed CBC performed in office. Admitted to Hospital Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 3/2/2010

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Convulsion, Meningitis, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 4/7/2010

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / AVENTIS PASTEUR SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Convulsion, Meningitis, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 8/31/2010

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardio-respiratory arrest, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 1/4/2011

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardio-respiratory arrest, Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 4/13/2011

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 5/13/2011

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 6/11/2011

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 5/13/2013

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 6/14/2014

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 2/14/2017

VAERS ID: 263520 Before After
VAERS Form:
Age:0.1 0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications:
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 5/14/2017

VAERS ID: 263520 Before After
VAERS Form:
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Convulsion, Meningitis, Pyrexia, Anoxic encephalopathy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 9/14/2017

VAERS ID: 263520 Before After
VAERS Form:(blank) 1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 2/14/2018

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 6/14/2018

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 8/14/2018

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 9/14/2018

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 10/14/2018

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 12/24/2020

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 12/30/2020

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 5/7/2021

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06


Changed on 5/21/2021

VAERS ID: 263520 Before After
VAERS Form:1
Age:0.14
Sex:Male
Location:South Carolina
Vaccinated:2006-08-31
Onset:2006-09-05
Submitted:2006-09-25
Entered:2006-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B047BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF011AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08655AA / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-08
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? No
Previous Vaccinations:
Other Medications: none
Current Illness: Fever of Unknown Origin
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CBC and lumbar puncture done in office. Cerebral spinal fluid brought to hospital by family. CBC, BMP, and blood cultures ordered when arrival to pediatric unit.
CDC 'Split Type':

Write-up: Received 2 month shots on 8/31/06: Pediarix, Prevnar, Acthib, and Rotateq. Office visit on 9/5/06 presenting with fever of unknown origin. Family stated fever as high as 102.3 rectally. At time of visit temp was 100.3 rectally post tylenol. LP and CBC performed in office. Admitted to Hospital. 10/13/06 Received D/C Summary from hospital which reveals the primary Dx as meningitis, cardiac arrest & seizures. Patient had neurologic devastation s/p cardiac arrest, family requested palliative care & comfort measures. Patient expired on 10/8/06

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