From the 9/14/2018 release of VAERS data (an older release, current is 10/8/2021):
This is VAERS ID 288471
| Days after vaccination:||1
| Days after onset:||3
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS
||AC21B114BB / 1
||- / IM
|HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC.
||0077U / 1
||- / IM
|PNC: PNEUMO (PREVNAR) / PFIZER/WYETH
||B08700H / 1
||- / IM
|RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC.
||0971U / 1
||MO / PO
Administered by: Private Purchased by: Public
Symptoms: Respiratory arrest,
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Date died: 2007-08-17
Days after onset: 0
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Other Medications: Infant Tylenol
Current Illness: None
Preexisting Conditions: None Umbilical hernia
Diagnostic Lab Data: Unavailable Autopsy Findings: Acetaminophen level 13 mg/L & CAH 17-OHP level abnormal.
CDC Split Type:
Write-up: Prelim reported that pt''s vomited and gone to respiratory arrest. 8/21/07 Spoke w/MD who states patient was in good health on day of vax. Looked tired but exam was WNL. Family concerned only about umbilical hernia. 8/21/07 Received pcp medical records & vax records which confirm RO dose & lot # as reported. Records indicate patient was in good health on day of vax w/only medical concern umbilical hernia. 3/11/08 Autopsy report states COD as undetermined.
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