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This is VAERS ID 478441

(NOTE: This result is from the 3/14/2015 version of the VAERS database)

Case Details

VAERS ID: 478441 (history)  
Form: Version .0  
Age: 0.1  
Sex: Male  
Location: California  
Vaccinated:2012-11-29
Onset:2012-12-17
   Days after vaccination:18
Submitted: 2012-12-17
   Days after onset:0
Entered: 2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO

Administered by: Private       Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, 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), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2012-12-17
   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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC Split Type:

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20150314&IDNUMBER=478441


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