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This is VAERS ID 338667

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 338667
VAERS Form:
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 021052 / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Sudden infant death syndrome, Autopsy, Toxicologic test normal, Culture negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 3/2/2010

VAERS ID: 338667 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 LL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 021052 / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Sudden infant death syndrome, Autopsy, Toxicologic test normal, Culture negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 4/7/2010

VAERS ID: 338667 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 LL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 021052 / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Sudden infant death syndrome, Autopsy, Toxicologic test normal, Culture negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 8/31/2010

VAERS ID: 338667 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 LL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 021052 / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Sudden infant death syndrome, Autopsy, Toxicologic test normal, Culture negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 7/7/2013

VAERS ID: 338667 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Sudden infant death syndrome, Autopsy, Toxicologic test normal, Culture negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 4/14/2017

VAERS ID: 338667 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 3 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Sudden infant death syndrome, Autopsy, Toxicologic test normal, Culture negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 9/14/2017

VAERS ID: 338667 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 1 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 0 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 0 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 3 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 0 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 2/14/2018

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 6/14/2018

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 8/14/2018

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 9/14/2018

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 10/14/2018

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 12/24/2020

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 12/30/2020

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 5/7/2021

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.


Changed on 5/21/2021

VAERS ID: 338667 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Pennsylvania
Vaccinated:2009-01-27
Onset:2009-01-28
Submitted:2009-01-28
Entered:2009-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2810AA / 2 RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB274AD / 1 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1369X / 1 LL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 021052 / 4 RL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1406X / 1 LL / UN

Administered by: Private      Purchased by: Private
Symptoms: Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2009-01-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy is being performed
CDC 'Split Type':

Write-up: Sudden death at home morning of 1/28/09. 6/1/09 Autopsy report states COD as sudden unexpected infant death & manner of death as natural. Report also states patient found dead in crib, tox screens & cultures all neg.

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