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This is VAERS ID 299918

Case Details

VAERS ID: 299918 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Oklahoma  
Vaccinated:2007-12-05
Onset:2007-12-08
   Days after vaccination:3
Submitted: 2007-12-14
   Days after onset:6
Entered: 2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 1 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 1 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013H / 1 LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2007-12-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Possible Reflux/Second Hand Smoke Exposure PMH: necrotizing enterocolitis at 1 wk of age. 2 1/2 wks premature. Birth HX: 6 lbs 12 oz, apgars 8/8 at 1/5 min. C-section due to fetal tachycardia & maternal temp of 100.6. Blood c/s neg.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. expired 3 days after ck-up. Parents reportedly found child dead in bed. 6/20/08 Autopsy states COD as SIDS. Report states pathological diagnosis as patent foramen ovale; lungs w/congestion & atelectasis; small bowel IS; GERD. Found unresponsive in bassinet after being placed prone approx 5 hrs earlier. CPR initiated 1/4/08 Reviewed pcp medical records & vax records which confirms vax as reported. Records indicate patient in good health on day of vax, only concern was constipation & formula changed.


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