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This is VAERS ID 264995

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264995
VAERS Form:
Age:0.1
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, INC. - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. - / - UN / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES - / - UN / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 12/8/2009

VAERS ID: 264995 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR - / - UN / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 3/2/2010

VAERS ID: 264995 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES - / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 4/7/2010

VAERS ID: 264995 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 5/13/2013

VAERS ID: 264995 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 2/14/2017

VAERS ID: 264995 Before After
VAERS Form:
Age:0.1 0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR - / - UN / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 5/14/2017

VAERS ID: 264995 Before After
VAERS Form:
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR SANOFI PASTEUR - / - UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR - / - UN / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH - / - UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - - / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 9/14/2017

VAERS ID: 264995 Before After
VAERS Form:(blank) 1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / - UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 1 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / - UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / - UNK - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 2/14/2018

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 6/14/2018

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 8/14/2018

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 9/14/2018

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 10/14/2018

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 12/24/2020

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 12/30/2020

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 5/7/2021

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.


Changed on 5/21/2021

VAERS ID: 264995 Before After
VAERS Form:1
Age:0.11
Sex:Male
Location:New York
Vaccinated:2006-09-20
Onset:2006-10-13
Submitted:2006-10-17
Entered:2006-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR - / UNK UN / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. - / 2 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / UNK UN / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0847F / UNK MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Coma, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-13
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Apparent sudden infant death syndrome, fed normally at 1am, found unresponsive at 5:30am.

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