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This is VAERS ID 299918

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 299918
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013H / 0 LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
Current Illness:
Preexisting Conditions: Possible Reflux/Second Hand Smoke Exposure
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. expired 3 days after ck-up. Parents reportedly found child dead in bed.


Changed on 12/8/2009

VAERS ID: 299918 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013H / 0 LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Atelectasis, Atrial septal defect, Constipation, Death, Gastrooesophageal reflux disease, Intussusception, Pulmonary congestion, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 3/2/2010

VAERS ID: 299918 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC B54013H / 0 LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Atrial septal defect, Constipation, Gastrooesophageal reflux disease, Intussusception, Pulmonary congestion, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 4/7/2010

VAERS ID: 299918 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC B54013H / 0 LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Atrial septal defect, Constipation, Gastrooesophageal reflux disease, Intussusception, Pulmonary congestion, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 8/31/2010

VAERS ID: 299918 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH B54013H / 0 LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Atrial septal defect, Constipation, Gastrooesophageal reflux disease, Intussusception, Pulmonary congestion, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 5/13/2013

VAERS ID: 299918 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013H / 0 LA / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Atrial septal defect, Constipation, Gastrooesophageal reflux disease, Intussusception, Pulmonary congestion, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 2/14/2017

VAERS ID: 299918 Before After
VAERS Form:
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013H / 0 LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Atelectasis, Atrial septal defect, Constipation, Gastrooesophageal reflux disease, Intussusception, Pulmonary congestion, Sudden infant death syndrome, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 9/14/2017

VAERS ID: 299918 Before After
VAERS Form:(blank) 1
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
Entered:2007-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B128AB / 0 1 RA / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0995U / 0 1 LA / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH B54013H / 0 1 LA / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1393U / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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.


Changed on 2/14/2018

VAERS ID: 299918 Before After
VAERS Form:1
Age:0.2
Gender:Male
Location:Oklahoma
Vaccinated:2007-12-05
Onset:2007-12-08
Submitted:2007-12-14
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:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2007-12-08
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:
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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