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This is VAERS ID 465434

(NOTE: This result is from the 2/14/2018 version of the VAERS database)

Case Details

VAERS ID: 465434 (history)  
Form: Version 1.0  
Age: 0.15  
Sex: Male  
Location: Indiana  
Vaccinated:2012-09-14
Onset:2012-09-15
   Days after vaccination:1
Submitted: 2012-09-18
   Days after onset:3
Entered: 2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B330CE / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0419AE / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918246 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Death, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-09-15
   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: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Child received vaccines on 9/14/12. Parent reported found child unresponsive on 9/15/12. Taken by ambulance to ER and pronounced.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180214&IDNUMBER=465434


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