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This is VAERS ID 475176

(NOTE: This result is from the 6/14/2018 version of the VAERS database)

Case Details

VAERS ID: 475176 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Male  
Location: Washington  
Vaccinated:2012-10-29
Onset:2012-11-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Death, Sudden infant death syndrome
SMQs:, Neonatal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-11-01
   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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Died of SIDS 2 days after receiving vaccines.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20180614&IDNUMBER=475176


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