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This is VAERS ID 353311

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 353311
VAERS Form:
Age:0.2
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D24322 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Benign neoplasm of thymus, Death, Obstructive airways disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 3/2/2010

VAERS ID: 353311 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D24322 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Benign neoplasm of thymus, Death, Obstructive airways disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 4/7/2010

VAERS ID: 353311 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D24322 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Benign neoplasm of thymus, Death, Obstructive airways disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 8/31/2010

VAERS ID: 353311 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D24322 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Benign neoplasm of thymus, Death, Obstructive airways disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 5/13/2013

VAERS ID: 353311 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Benign neoplasm of thymus, Death, Obstructive airways disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 2/14/2017

VAERS ID: 353311 Before After
VAERS Form:
Age:0.2 0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: Benign neoplasm of thymus, Death, Obstructive airways disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 9/14/2017

VAERS ID: 353311 Before After
VAERS Form:(blank) 1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 1 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 2/14/2018

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 6/14/2018

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 8/14/2018

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 9/14/2018

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 10/14/2018

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 12/24/2020

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 12/30/2020

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 5/7/2021

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.


Changed on 5/21/2021

VAERS ID: 353311 Before After
VAERS Form:1
Age:0.15
Sex:Male
Location:Colorado
Vaccinated:2009-08-05
Onset:0000-00-00
Submitted:2009-08-06
Entered:2009-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3277AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBV663AA / 2 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D24322 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA692A / 1 MO / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-08-06
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: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: none, 9/25/09 Autopsy report received - Cause of Death - Probable Partial Mechanical Obstruction of Airway by Ectopic Thymus. By history baby developed "noisy breathing" by evening. Found prone and unresponsive. Only explanation for abnormal breathing sounds was a benign growth, an extra thymus gland, growing in the wrong place next to his trachea.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=353311&WAYBACKHISTORY=ON


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