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This is VAERS ID 263568

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 263568
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, rec"eived vaccine 8/9/06


Changed on 12/8/2009

VAERS ID: 263568 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, rec"eived received vaccine 8/9/06


Changed on 5/13/2013

VAERS ID: 263568 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 2/14/2017

VAERS ID: 263568 Before After
VAERS Form:
Age:0.3 0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 9/14/2017

VAERS ID: 263568 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 2/14/2018

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 6/14/2018

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 8/14/2018

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 9/14/2018

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 10/14/2018

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 12/24/2020

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 12/30/2020

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 5/7/2021

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06


Changed on 5/21/2021

VAERS ID: 263568 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:North Carolina
Vaccinated:2006-09-12
Onset:2006-09-21
Submitted:2006-09-21
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0139F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-09-21
Permanent Disability? No
Recovered? No
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NC06086

Write-up: Death occurred at night in home, unwitnessed, possible SIDS, previously healthy with mild CER, autopsy performed, genetics involved second to strong family history of developmental delay and psychiatric d/o. Pt in phase III clinical trial of HibMency, received vaccine 8/9/06

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