Age: 0.5
Sex: F
Vaccine: DTAPHEPBIP, FLU3, PNC, RV5
Symptoms: Breath sounds abnormal, Capillary nail refill test, Cardiac arrest, Cardio-respiratory arrest, Crying
Clinical narrative: This report was received from the Centers for Disease Control and Prevention (VAERS ID 302826) via a healthcare provider and described the occurrence of death nos in a 6-month-old female subject who was vaccinated with PEDIARIX, (GlaxoSmithKline).  History was unremarkable.  No previous hospitalizations.  At the 6 month examination, the mother was told that the subject needed "tummy time" to develop the trunk tone.  Previous and/or concurrent vaccination included inactivated influenza vaccine; Sanofi Pasteur; given on 20 December 2007; live attenuated human rotavirus vaccine; Merck; given on 20 December 2007; pneumococcal vaccine, unspecified; Wyeth given on 20 December 2007.  On 20 December 2007 the subject received 3rd dose of PEDIARIX (unknown).  In December 2007, 2 days after vaccination with PEDIARIX, the subject experienced death nos and cardiopulmonary arrest.  The subject presented to the emergency room into cardiac arrest on full code, asystole and was resuscitated and the heart rate was brought back after several minutes.  According to the mother, she left the child prone over a blanket that had the four ends secure so it would not fold and left the room.  She had heard the subject cry because, according to her, she did not like to be prone.  She had heard the subject cry 5 minutes before she went back into the room and found her completely unresponsive.  She started CPR and paramedics were called who arrived in another 5 minutes.  The subject was intubated and transferred her to the emergency room.  CT scan done in the emergency room showed no bleeding or edema with normal ventricles.  The subject was transferred and hospitalized in the pediatric intensive care unit.  Physical examination showed the baby to be unresponsive to stimuli with gasping rhythmic chest movement with no effective ventilation.  The pupils were 5 mm and fixed.  The subject was on the respiratory oxygenating well.  The capillary refill was fair to poor approximately 4-5 seconds.  Air entry was good and the heart with rhythmic with no murmur.  The abdomen was soft.  There were no bruises on the body or head of the subject.  There was no gag reflex.  A CT scan done at the emergency room showed no bleeding or edema with normal ventricles.  Subject was placed on mechanical ventilation.  A femoral line was placed.  The subject was started on dopamine and DOBUTMINE for low blood pressure and poor perfusion and responded well.  The subject also received albumin 5 percent.  Venous blood gases showed normal oxygenation and ventilation.  Repeat CT scan still did not show any brain edema or hemorrhage.  An EEG was nearly flat that day with no significant cortical activity.  It was reported that over the next 24 hours, nurse noted that the subject had at one points some very sluggish pupil reaction and even very mild response to deep pain in the lower extremities only.  The subject died from death nos.  It was unknown whether an autopsy was performed.  A CT scan done at the emergency room showed no bleeding or edema with normal ventricles.  The next day, repeat CT scan still did not show any brain edema or hemorrhage.  An EEG was nearly flat that day with no significant cortical activity.