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This is VAERS ID 267630

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 267630
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. - / - UN / -

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

Life Threatening? Yes
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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perf"ect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to


Changed on 12/8/2009

VAERS ID: 267630 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:0000-00-00 2006-10-20
Onset:0000-00-00 2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086918 / 0 LA / IM
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - 0577F / - 0 UN - / - PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Sudden infant death syndrome, Abnormal sleep-related event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:0000-00-00 2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perf"ect perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 3/2/2010

VAERS ID: 267630 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B086918 / 0 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome, Abnormal sleep-related event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 4/7/2010

VAERS ID: 267630 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B086918 / 0 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome, Abnormal sleep-related event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 8/31/2010

VAERS ID: 267630 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B086918 / 0 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome, Abnormal sleep-related event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 5/13/2013

VAERS ID: 267630 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 0 LA / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome, Abnormal sleep-related event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 5/14/2017

VAERS ID: 267630 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 0 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome, Abnormal sleep-related event

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 9/14/2017

VAERS ID: 267630 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 0 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 2/14/2018

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 6/14/2018

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 8/14/2018

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 9/14/2018

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 10/14/2018

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 12/24/2020

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 12/30/2020

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 5/7/2021

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.


Changed on 5/21/2021

VAERS ID: 267630 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2006-10-20
Onset:2006-10-21
Submitted:2006-11-16
Entered:2006-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B070AA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UE932AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B086918 / 1 LA / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0577F / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-10-21
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: UNK
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02595

Write-up: Information has been received from a physician concerning a 2 month old female who was vaccinated with a 2ml dose of Rotavirus vaccine. On the next day, the pt died. The physician stated that the infant received all of her vaccines on time and wad in perfect health. The medical examiner ruled the cause of death as sudden infant death syndrome. Unspecified medical attention was sought. No product quality complaint was involved. NO other information was provided. The reporter considered the pts reaction to be immediately life threatening. Additional information has been requested. 12/28/06 Received autopsy report which reveals COD as Category II SIDS, cosleeping with parents in adult bed. Manner of death undetermined.

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