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This is VAERS ID 360138

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 360138
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? No
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? Yes, days: 39     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 1/5/2010

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2009-10-05
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? Yes, days: 39     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 3/2/2010

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 39     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 4/7/2010

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 39     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 7/31/2010

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 39 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 8/31/2010

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Rash, Status epilepticus, Urine analysis, Citrobacter infection, Thyroxine free decreased, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 1/4/2011

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Rash, Status epilepticus, Urine analysis, Citrobacter infection, Thyroxine free decreased, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 4/13/2011

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 5/13/2011

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 6/11/2011

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 5/13/2013

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 6/14/2014

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 2/14/2017

VAERS ID: 360138 Before After
VAERS Form:
Age:0.3 0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 4/14/2017

VAERS ID: 360138 Before After
VAERS Form:
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood calcium decreased, Blood chloride increased, Blood creatinine increased, Blood fibrinogen increased, Blood gases, Blood glucose increased, Blood magnesium increased, Blood sodium increased, Blood urea increased, Bronchopneumonia, C-reactive protein increased, Chest X-ray abnormal, Computerised tomogram, Computerised tomogram abnormal, Convulsion, CSF protein increased, Death, Differential white blood cell count, Drug level decreased, Dyskinesia, Dyspnoea, Electroencephalogram abnormal, Epilepsy, Fibrin D dimer increased, Full blood count, Gliosis, Haematocrit decreased, Hiccups, Hypotension, Hypotonia, Ileus, Intensive care, International normalised ratio increased, Metabolic acidosis, Nuclear magnetic resonance imaging brain, Nuclear magnetic resonance imaging brain abnormal, Peritonitis, Prothrombin time prolonged, Pulse abnormal, Rash, Rash erythematous, Respiratory failure, Status epilepticus, Tachycardia, Tracheitis, Urinary bladder haemorrhage, Urinary tract infection, Urine analysis, White blood cell count increased, X-ray abnormal, Blood phosphorus increased, Anoxic encephalopathy, CSF glucose increased, Citrobacter infection, Neutrophil percentage increased, Lymphocyte percentage decreased, Fontanelle depressed, Mean platelet volume increased, Thyroxine free decreased, Staphylococcal infection, Abdominal compartment syndrome, CSF test abnormal, Cytogenetic analysis abnormal, Abdominal X-ray, Metabolic function test, Herpes simplex serology negative, Mechanical ventilation, Brain injury, CSF white blood cell differential

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 9/14/2017

VAERS ID: 360138 Before After
VAERS Form:(blank) 1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / - UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / - UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / - UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / - UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 2/14/2018

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 6/14/2018

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 8/14/2018

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 9/14/2018

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 10/14/2018

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 12/24/2020

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 12/30/2020

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 5/7/2021

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.


Changed on 5/21/2021

VAERS ID: 360138 Before After
VAERS Form:1
Age:0.27
Sex:Male
Location:Kentucky
Vaccinated:2009-09-02
Onset:2009-09-03
Submitted:0000-00-00
Entered:2009-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B208AA / UNK RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF596AB / UNK LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D74257 / UNK LL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FA732A / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Blood gases, Computerised tomogram, Convulsion, Differential white blood cell count, Dyspnoea, Electroencephalogram abnormal, Full blood count, Intensive care, Nuclear magnetic resonance imaging brain, Status epilepticus, Urine analysis, Metabolic function test, Herpes simplex serology negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-10-05
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? Yes, days: 32     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Known
Preexisting Conditions: Inguinal Hernia.
Allergies:
Diagnostic Lab Data: CBCw Diff; CMP; ABG; Urinalysis; HSV, Negative; PCS, negative; CT; Brain MRI; EEG, left temporal focus
CDC 'Split Type':

Write-up: 3 mo old infant received multiple vaccines to include PEDIARIX, HIB, PREVNAR, and ROTARIX during well child visit on September 2nd. On September 3rd. he was brought to Pediatric Clinic by his mother with c/o "trouble breathing". When the physician came into the room, the infant was noted to be seizing. A CBC, CMP, ABG and urine samples were also collected. He was diagnosed with Status Epilepticus and taken to a Hospital where he was admitted to PICU. A CT and brain MRI were completed. EEG demonstrated left temporal focus; HSV PCS & culture were negative; the initial infant screen was insufficient, repeat infant screen, ID & genetic consults are pending.

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