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This is VAERS ID 376710

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 376710
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 3/2/2010

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 4/7/2010

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 8/31/2010

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 4/13/2011

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Accident, Asphyxia, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 5/13/2011

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Accident, Asphyxia, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 6/11/2011

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Accident, Asphyxia, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 7/7/2013

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Accident, Asphyxia, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 3/14/2015

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Accident, Asphyxia, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 2/14/2017

VAERS ID: 376710 Before After
VAERS Form:
Age:0.5 0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 9/14/2017

VAERS ID: 376710 Before After
VAERS Form:(blank) 1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / - UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / - UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / - UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 2/14/2018

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 6/14/2018

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 8/14/2018

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 9/14/2018

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 10/14/2018

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 12/24/2020

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 12/30/2020

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 5/7/2021

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.


Changed on 5/14/2021

VAERS ID: 376710 Before After
VAERS Form:1
Age:0.53
Sex:Male
Location:New York
Vaccinated:2010-01-08
Onset:2010-01-11
Submitted:2010-01-12
Entered:2010-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3431AA / UNK UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3167FA / UNK UN / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D39016 / UNK UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-11
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: According to mother, mom called office stated that she walked into baby room he was unresponsive, she called EMS and baby was taken to local ER where he was pronounced dead. Have not spoken to mother, she called office and spoke with nurse.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=376710&WAYBACKHISTORY=ON


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