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This is VAERS ID 266205

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 266205
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, INC. U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child wa"s brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06.


Changed on 12/8/2009

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child wa"s was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 8/31/2010

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 4/13/2011

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 5/13/2011

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 6/11/2011

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 7/7/2013

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 2/14/2017

VAERS ID: 266205 Before After
VAERS Form:
Age:1.1 1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 5/14/2017

VAERS ID: 266205 Before After
VAERS Form:
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U2196AA / 0 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Febrile convulsion, Leukocytosis, Medication error, Pyrexia, Respiratory failure, White blood cell count increased, Procedural complication, Endotracheal intubation complication

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 9/14/2017

VAERS ID: 266205 Before After
VAERS Form:(blank) 1
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 0 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 2 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 0 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 2/14/2018

VAERS ID: 266205 Before After
VAERS Form:1
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 6/14/2018

VAERS ID: 266205 Before After
VAERS Form:1
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 8/14/2018

VAERS ID: 266205 Before After
VAERS Form:1
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 9/14/2018

VAERS ID: 266205 Before After
VAERS Form:1
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.


Changed on 10/14/2018

VAERS ID: 266205 Before After
VAERS Form:1
Age:1.09
Sex:Male
Location:Texas
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-11-07
Entered:2006-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2196AA / 1 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER C0806 / 3 - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 1 - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia, Respiratory failure, White blood cell count increased

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2006-11-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient reportedly was given Versed by EMT approximately 45 minutes before respiratory arrest
Current Illness: none reported
Preexisting Conditions: child was born at 34-35 gestation. Is a fraternal twin; sister received same immunizations at same visit on 11/2/06.
Allergies:
Diagnostic Lab Data: WBC 44,800, Potassium 3.3; rectal temp in ER 101.8
CDC 'Split Type':

Write-up: Apparently healthy 13 montly old fraternal male twin received vaccines (see below) at approximately 9AM on 11/2/06. Approximately 12 hours later child experienced seizure at home. EMT came to home and gave Versed to patient at about 10:30PM and child was brought to ER. Temp at ER 101.8 (rectal). At about 11:15PM child experienced respiratory failure, attempte was made to intubate; child pronounced dead at approximately 12:02AM on 11/3/06. 2/22/07 Received autopsy report which reveals COD as complications of midazolam administration following a s/p vaccination benign febrile seizure.

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