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This is VAERS ID 459500

(NOTE: This result is from the 2/14/2017 version of the VAERS database)

Case Details

VAERS ID: 459500 (history)  
Form: Version .0  
Age: 0.46  
Sex: Male  
Location: Oregon  
Vaccinated:2012-06-27
Onset:2012-06-28
   Days after vaccination:1
Submitted: 2012-07-17
   Days after onset:19
Entered: 2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 1 - / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Autopsy, Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-06-28
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC Split Type:

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170214&IDNUMBER=459500


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