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This is VAERS ID 267625

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 267625
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / -
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 3/2/2010

VAERS ID: 267625 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES - / - UN / -
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 4/7/2010

VAERS ID: 267625 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / -
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 5/13/2013

VAERS ID: 267625 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / -
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 2/14/2017

VAERS ID: 267625 Before After
VAERS Form:
Age:0.3 0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 5/14/2017

VAERS ID: 267625 Before After
VAERS Form:
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH - / - UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 9/14/2017

VAERS ID: 267625 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 2/14/2018

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 6/14/2018

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 8/14/2018

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 9/14/2018

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 10/14/2018

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 12/24/2020

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 12/30/2020

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 5/7/2021

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.


Changed on 5/21/2021

VAERS ID: 267625 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Foreign
Vaccinated:0000-00-00
Onset:2006-11-10
Submitted:2006-11-21
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK UN / -
RVX: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hypoxia, Pallor, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRWYE589520NOV06

Write-up: Information regarding Prevnar was received from a healthcare professional regarding a 3 month old male pt who experienced sudden death. The pt received the first dose on 11/09/06. The pt had no medical history, particularly no history of either gastroesophageal reflux, or transient respiratory arrest, his birth was normal and he had no pertinent family history. Indication for Prevnar was immunisation. Product was administered on 11/9/06. Dose regimen was 1 dose (IM). Additional suspect medication included Tetravalent (diphtheria vaccine/haemophilus influenzae B/pertussis vaccine/tetanus vaccine) and Rotarix. Concomitant medications were not reported. The pt experienced sudden death on 11/10/06. The pt was fed by bottle at midday. In the afternoon while he slept on a double bed for an unspecified length of time (several minutes), he was found white and in respiratory arrest. After resuscitation by firemen, heart and respiratory rates reappeared. The pt was admitted in intensive care unit where heart and respiratory rates were artificially maintained by resuscitation. The investigations done for searching and infection were neg. Finally resuscitation was stopped on 11/12/06 and the pt died. Nuclear magnetic resonance imaging results normal was done on 11/10/06. Autopsy pending results was done on 11/12/06. The cause of death was reported as sudden death and an autopsy was performed, but results were not provided. No additional information was available at the time of this report.

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