National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 269004

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 269004
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C2627AA / 0 LL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATORIES B08649A / 0 RL / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am.


Changed on 12/8/2009

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATORIES WYETH PHARMACEUTICALS, INC B08649A / 0 RL / -
ROTHB5: ROTAVIRUS VACCINE, LIVE, ORAL, PENTAVALENT (ROTATEQ) ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 3/2/2010

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B08649A / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 4/7/2010

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B08649A / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 8/31/2010

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B08649A / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 5/13/2013

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 0 RL / -
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 6/14/2014

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 3/14/2015

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 2/14/2017

VAERS ID: 269004 Before After
VAERS Form:
Age:0.2 0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 0 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death of relative, Laboratory test abnormal, Paracentesis eye abnormal, Rib fracture, Strabismus, Sudden infant death syndrome, Unresponsive to stimuli, Brain oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 9/14/2017

VAERS ID: 269004 Before After
VAERS Form:(blank) 1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 0 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 0 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 2/14/2018

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 6/14/2018

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 8/14/2018

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 9/14/2018

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 10/14/2018

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 12/24/2020

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 12/30/2020

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 5/7/2021

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.


Changed on 5/21/2021

VAERS ID: 269004 Before After
VAERS Form:1
Age:0.19
Sex:Male
Location:Virginia
Vaccinated:2006-12-04
Onset:2006-12-09
Submitted:2006-12-13
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2627AA / 1 LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B08649A / 1 RL / -
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0389F / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-09
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: Pt received Daptacel, Prevnar and Rotateq on 12/04/2006. Also his twin brother received at the same time. Did not have any SX. On 12/09/06 mom fed them at 5am and found them dead at 9:00 am. 6/29/07 Received Autopsy Report which reveals COD as Undetermined & contributing condition simultaneous death of twin brother. Pathological Dx: I. Sudden unexpected infant death A. Twin B infant male found unresponsive in crib on stomach B. Vitreous electrolytes, abnormal, w/decreased Na & increased Cl, urea nitrogen, calcium, carbon dioxide C. Brain congestion & edema, neuronal heterotopia & insular micro-dysgenesis, mild focal. II. Ancillary studies, other, non-contributory. III. Simultaneous death of twin brother IV. Fractures, ribs, anterior & lateral, w/minimal hemorrhage.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269004&WAYBACKHISTORY=ON


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