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This is VAERS ID 337671

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 337671
VAERS Form:
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D0107S / 2 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 3/2/2010

VAERS ID: 337671 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D0107S / 2 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 4/7/2010

VAERS ID: 337671 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D0107S / 2 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 8/31/2010

VAERS ID: 337671 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D0107S / 2 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 4/14/2017

VAERS ID: 337671 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 2 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 9/14/2017

VAERS ID: 337671 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 2 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 2/14/2018

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 6/14/2018

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 8/14/2018

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 9/14/2018

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 10/14/2018

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 12/24/2020

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 12/30/2020

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 5/7/2021

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.


Changed on 5/21/2021

VAERS ID: 337671 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Arkansas
Vaccinated:2009-01-13
Onset:0000-00-00
Submitted:2009-01-16
Entered:2009-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR SPC3230AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D0107S / 3 RL / IM

Administered by: Public      Purchased by: Other
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was administered vaccines on 013109. Pt was found deceased on 011409. 10/28/09 Autopsy report received. DOD 11/14/09 Cause of Death: Sudden Unexplained Infant Death. Additional information extracted: Suddent Infant Death Syndrome.

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