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This is VAERS ID 265462

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 265462
VAERS Form:
Age:0.1
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES - / 0 - / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 12/8/2009

VAERS ID: 265462 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (UNKNOWN MFR) HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (UNKNOWN MFR) HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / 0 - / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 3/2/2010

VAERS ID: 265462 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 4/7/2010

VAERS ID: 265462 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 5/13/2013

VAERS ID: 265462 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / 0 - / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 2/14/2017

VAERS ID: 265462 Before After
VAERS Form:
Age:0.1 0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 5/14/2017

VAERS ID: 265462 Before After
VAERS Form:
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH - / 0 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 9/14/2017

VAERS ID: 265462 Before After
VAERS Form:(blank) 1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 0 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 2/14/2018

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 6/14/2018

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 8/14/2018

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 9/14/2018

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 10/14/2018

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 12/24/2020

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 12/30/2020

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 5/7/2021

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.


Changed on 5/21/2021

VAERS ID: 265462 Before After
VAERS Form:1
Age:0.13
Sex:Female
Location:Washington
Vaccinated:2006-10-02
Onset:2006-10-02
Submitted:2006-10-19
Entered:2006-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / 1 - / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Coma, Fatigue, Irritability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-10-04
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: Born premature 3 weeks 1 day early and low birth weight.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After administering vaccines child became very fussy and over tired, would not wake to eat and passed away a little over a day later. Autopsy could not say that vaccines did not play role in death.

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