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This is VAERS ID 336841

(NOTE: This result is from the 4/7/2010 version of the VAERS database)

Case Details

VAERS ID: 336841 (history)  
Form: Version .0  
Age: 0.2  
Gender: Female  
Location: Illinois  
Vaccinated:2008-11-18
Onset:2008-12-04
   Days after vaccination:16
Submitted: 2009-01-09
   Days after onset:36
Entered: 2009-01-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 0 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C68309 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Autopsy, Death, Inflammation, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2008-12-04
   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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20100407&IDNUMBER=336841


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