National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 268705

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 268705
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08672D / 0 RL / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS.


Changed on 12/8/2009

VAERS ID: 268705 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP HEPB IPV (PEDIARIX) / GLAXOSMITHKLINE AC21B069AA / 0 LL / -
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672D / 0 RL / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 3/2/2010

VAERS ID: 268705 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES B08672D / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 4/7/2010

VAERS ID: 268705 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672D / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 5/13/2013

VAERS ID: 268705 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672D / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 2/14/2017

VAERS ID: 268705 Before After
VAERS Form:
Age:0.2 0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES B08672D / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 5/14/2017

VAERS ID: 268705 Before After
VAERS Form:
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH B08672D / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 9/14/2017

VAERS ID: 268705 Before After
VAERS Form:(blank) 1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 0 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 0 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 0 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 2/14/2018

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 6/14/2018

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 8/14/2018

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 9/14/2018

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 10/14/2018

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 12/24/2020

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 12/30/2020

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 5/7/2021

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.


Changed on 5/21/2021

VAERS ID: 268705 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Pennsylvania
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B069AA / 1 LL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0276F / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08672D / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0726F / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-05
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was put to bed normally on 12/04/06. Parents woke 12/5 a.m. to find baby unresponsive, pronounced dead at the scene. Medical examiner preliminary report- suspected SIDS. 3/15/07 Received Autopsy Report which reveals COD as Sudden Unexplained Infant Death Syndrome.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=268705&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166