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This is VAERS ID 352162

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 352162
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L)
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 2/5/2010

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L)
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 3/2/2010

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L)
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 4/7/2010

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L)
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 7/31/2010

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L)
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 8/31/2010

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory distress syndrome, Death, Multiple injuries, Retinal haemorrhage, Anoxic encephalopathy, Traumatic brain injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L)
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 1/4/2011

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Acute respiratory distress syndrome, Death, Multiple injuries, Retinal haemorrhage, Anoxic encephalopathy, Traumatic brain injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 4/13/2011

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 5/13/2011

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 6/11/2011

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 5/13/2013

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 2/14/2017

VAERS ID: 352162 Before After
VAERS Form:
Age:0.2 0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Acute respiratory distress syndrome, Alanine aminotransferase increased, Albumin globulin ratio abnormal, Areflexia, Aspartate aminotransferase increased, Blood albumin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine phosphokinase increased, Blood culture negative, Blood glucose increased, Blood lactic acid increased, Chest X-ray abnormal, Computerised tomogram abnormal, Corneal oedema, Corneal reflex decreased, Culture urine positive, Death, Eosinophil count decreased, Fibrin D dimer increased, Haematocrit decreased, Haematocrit increased, Blood urine present, Haemoglobin decreased, Hypokinesia, Hypotonia, International normalised ratio increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Metabolic acidosis, Monocyte count decreased, Multi-organ failure, Multiple injuries, Neutrophil count decreased, Platelet count decreased, Pneumothorax, Protein total decreased, Prothrombin time prolonged, Pupil fixed, Retinal haemorrhage, Skin disorder, Subdural haemorrhage, Unresponsive to stimuli, Urine abnormality, White blood cell count decreased, Drug screen positive, Contusion, Anoxic encephalopathy, Eosinophil percentage decreased, Monocyte percentage decreased, Protein urine present, Glasgow coma scale abnormal, Bacterial culture positive, Victim of homicide, Blood alkaline phosphatase increased, Traumatic brain injury, Bacteria urine identified, Brain stem syndrome, Urine colour abnormal, Streptococcus identification test positive, Staphylococcus identification test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 9/14/2017

VAERS ID: 352162 Before After
VAERS Form:(blank) 1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 0 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 0 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 2/14/2018

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 6/14/2018

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 8/14/2018

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 9/14/2018

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 10/14/2018

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 12/24/2020

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 12/30/2020

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 5/7/2021

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.


Changed on 5/21/2021

VAERS ID: 352162 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Nevada
Vaccinated:2009-07-17
Onset:2009-07-22
Submitted:2009-07-22
Entered:2009-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B201BA / 1 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF608AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D36147 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-07-22
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: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/23/09 Medical records and DC summary received. LABS and DIAGNOSTICS: CT Brain - Frontal hemorrhage. CBC - WBC 2.28 (L) HGB 14.5 (H) HCT 40.3 (H) MCV 88 (H) MCHC 36.2 (H) PLT 76 (L) MONO 2.6% (L) EOS 0.0% (L) NEUT# 0.89 (L) LYMPH# 1.30 (L) MONO# 0.06 (L) EOS# 0.00 (L). Coagulation - Protime 15.7 (H) INR 1.7 (H) PTT 140 (H) D-DIMER 35.20 (H). CHEM - CL 124 (H) Glucose 255 (H) Total Protein 4.5 (L) Albumin 3.2 (L) A/G ratio 2.5 (H) Calcium 7.7 (L) SGOT/AST 162 (H) SGPT/ALT 319 (H) Total Alk Phos 579 (H) Total CK 688 (H) Lactate 9.7 (H). Urine Tox Screen - Benzodiazapines. Urinalysis - color red, cloudy, glucose 100, blood large amt, protein 100, bacteria trace. Urine culture - E. Coli. Tracheal culture - Strep agalactiae, Staph aureus. Blood culture - no growth. Chest X-ray - abnormal, right pneumothorax.
CDC 'Split Type':

Write-up: The baby died under suspicious conditions this morning. 7/23/09 Medical records and DC summary received. Assessment: Multisystem organ failure, severe traumatic brain injury, acute respiratory distress syndrome, metabolic acidosis, rule out nonaccidental trauma. Patient presents with frontal traumatic brain injury, bilateral pneumothoraces, decreased hemoglobin and hematocrit. Pupils are 4 mm and fixed. Does not move face or extremities. GCS of 6T. Bruising to frontal scalp area, left knee. No corneal (reflex) no gag (reflex), no movement to pain. Diffuse hypotonia. Preretinal hemorrhage. Corneal edema. Anoxic encephalopathy. Depressed brain stem reflexes.

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