National Vaccine
Information Center
Your Health. Your Family. Your Choice.

 MedAlerts Home
Search Results

This is VAERS ID 336841

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 336841
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 3/2/2010

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C68309 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 4/7/2010

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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 (PREVNAR7) 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: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 8/31/2010

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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 PFIZER/WYETH C68309 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 5/13/2013

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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) / PFIZER/WYETH C68309 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 6/14/2014

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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) / PFIZER/WYETH C68309 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 3/14/2015

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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) / PFIZER/WYETH C68309 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 2/14/2017

VAERS ID: 336841 Before After
VAERS Form:
Age:0.2 0.21
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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) / PFIZER/WYETH C68309 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 3/14/2017

VAERS ID: 336841 Before After
VAERS Form:
Age:0.21
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09
Entered:2009-01-08
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) / PFIZER/WYETH C68309 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
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: 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.

Changed on 4/14/2017

VAERS ID: 336841 Before After
VAERS Form:
Age:0.21 0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:2009-01-09 0000-00-00
Entered:2009-01-08
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) / PFIZER/WYETH C68309 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity Prematurity
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.

Changed on 9/14/2017

VAERS ID: 336841 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:0000-00-00
Entered:2009-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
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.

Changed on 2/14/2018

VAERS ID: 336841 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:0000-00-00
Entered:2009-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
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.

Changed on 6/14/2018

VAERS ID: 336841 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:0000-00-00
Entered:2009-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
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.

Changed on 8/14/2018

VAERS ID: 336841 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:0000-00-00
Entered:2009-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
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.

Changed on 9/14/2018

VAERS ID: 336841 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:0000-00-00
Entered:2009-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
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.

Changed on 10/14/2018

VAERS ID: 336841 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Illinois
Vaccinated:2008-11-18
Onset:2008-12-04
Submitted:0000-00-00
Entered:2009-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C2956AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF515AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR A0836 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C68309 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0641X / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
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.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=336841&WAYBACKHISTORY=ON


Copyright © 2019 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166