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This is VAERS ID 378368

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 378368
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 3/2/2010

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 4/7/2010

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 8/31/2010

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder, Urine protein/creatinine ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 1/4/2011

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder, Urine protein/creatinine ratio increased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 4/13/2011

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood urea increased, Bronchiolitis, Bronchitis, Carbon dioxide decreased, Chest X-ray abnormal, Cough, Death, Dyspnoea, Haematocrit decreased, Haemoglobin decreased, Hypertension, Intensive care, International normalised ratio increased, Lymphocyte count decreased, Meningitis, Meningitis bacterial, Nephropathy, Neutropenia, Neutrophil count decreased, Neutrophil toxic granulation present, Platelet count decreased, Protein total decreased, Proteinuria, Prothrombin time prolonged, Pyrexia, Red blood cell count decreased, Respiratory disorder, Septic shock, Urine abnormality, Viral infection, White blood cell count decreased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Nasal flaring, Protein urine present, Urobilin urine present, Urine protein/creatinine ratio increased, Pneumococcal sepsis, Decreased appetite, Use of accessory respiratory muscles

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 5/13/2011

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood urea increased, Bronchiolitis, Bronchitis, Carbon dioxide decreased, Chest X-ray abnormal, Cough, Death, Dyspnoea, Haematocrit decreased, Haemoglobin decreased, Hypertension, Intensive care, International normalised ratio increased, Lymphocyte count decreased, Meningitis, Meningitis bacterial, Nephropathy, Neutropenia, Neutrophil count decreased, Neutrophil toxic granulation present, Platelet count decreased, Protein total decreased, Proteinuria, Prothrombin time prolonged, Pyrexia, Red blood cell count decreased, Respiratory disorder, Septic shock, Urine abnormality, Viral infection, White blood cell count decreased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Nasal flaring, Protein urine present, Urobilin urine present, Urine protein/creatinine ratio increased, Pneumococcal sepsis, Decreased appetite, Use of accessory respiratory muscles

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 6/11/2011

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood urea increased, Bronchiolitis, Bronchitis, Carbon dioxide decreased, Chest X-ray abnormal, Cough, Death, Dyspnoea, Haematocrit decreased, Haemoglobin decreased, Hypertension, Intensive care, International normalised ratio increased, Lymphocyte count decreased, Meningitis, Meningitis bacterial, Nephropathy, Neutropenia, Neutrophil count decreased, Neutrophil toxic granulation present, Platelet count decreased, Protein total decreased, Proteinuria, Prothrombin time prolonged, Pyrexia, Red blood cell count decreased, Respiratory disorder, Septic shock, Urine abnormality, Viral infection, White blood cell count decreased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Nasal flaring, Protein urine present, Urobilin urine present, Urine protein/creatinine ratio increased, Pneumococcal sepsis, Decreased appetite, Use of accessory respiratory muscles

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 5/13/2013

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood urea increased, Bronchiolitis, Bronchitis, Carbon dioxide decreased, Chest X-ray abnormal, Cough, Death, Dyspnoea, Haematocrit decreased, Haemoglobin decreased, Hypertension, Intensive care, International normalised ratio increased, Lymphocyte count decreased, Meningitis, Meningitis bacterial, Nephropathy, Neutropenia, Neutrophil count decreased, Neutrophil toxic granulation present, Platelet count decreased, Protein total decreased, Proteinuria, Prothrombin time prolonged, Pyrexia, Red blood cell count decreased, Respiratory disorder, Septic shock, Urine abnormality, Viral infection, White blood cell count decreased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Nasal flaring, Protein urine present, Urobilin urine present, Urine protein/creatinine ratio increased, Pneumococcal sepsis, Decreased appetite, Use of accessory respiratory muscles

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 7/7/2013

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood urea increased, Bronchiolitis, Bronchitis, Carbon dioxide decreased, Chest X-ray abnormal, Cough, Death, Dyspnoea, Haematocrit decreased, Haemoglobin decreased, Hypertension, Intensive care, International normalised ratio increased, Lymphocyte count decreased, Meningitis, Meningitis bacterial, Nephropathy, Neutropenia, Neutrophil count decreased, Neutrophil toxic granulation present, Platelet count decreased, Protein total decreased, Proteinuria, Prothrombin time prolonged, Pyrexia, Red blood cell count decreased, Respiratory disorder, Septic shock, Urine abnormality, Viral infection, White blood cell count decreased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Nasal flaring, Protein urine present, Urobilin urine present, Urine protein/creatinine ratio increased, Pneumococcal sepsis, Decreased appetite, Use of accessory respiratory muscles

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 3/14/2015

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood bilirubin increased, Blood creatinine increased, Blood culture positive, Blood fibrinogen increased, Blood gases abnormal, Blood glucose increased, Blood lactic acid increased, Blood potassium decreased, Blood urea increased, Bronchiolitis, Bronchitis, Carbon dioxide decreased, Chest X-ray abnormal, Cough, Death, Dyspnoea, Haematocrit decreased, Haemoglobin decreased, Hypertension, Intensive care, International normalised ratio increased, Lymphocyte count decreased, Meningitis, Meningitis bacterial, Nephropathy, Neutropenia, Neutrophil count decreased, Neutrophil toxic granulation present, Platelet count decreased, Protein total decreased, Proteinuria, Prothrombin time prolonged, Pyrexia, Red blood cell count decreased, Respiratory disorder, Septic shock, Urine abnormality, Viral infection, White blood cell count decreased, Ultrasound abdomen abnormal, Neutrophil percentage increased, Monocyte percentage decreased, Lymphocyte percentage decreased, Nasal flaring, Protein urine present, Urobilin urine present, Urine protein/creatinine ratio increased, Pneumococcal sepsis, Decreased appetite, Use of accessory respiratory muscles

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 2/14/2017

VAERS ID: 378368 Before After
VAERS Form:
Age:0.5 0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 - / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 9/14/2017

VAERS ID: 378368 Before After
VAERS Form:(blank) 1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 2 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 0 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 2 3 - MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 2/14/2018

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 6/14/2018

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 8/14/2018

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 9/14/2018

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 10/14/2018

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 12/24/2020

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 12/30/2020

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 5/7/2021

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.


Changed on 5/14/2021

VAERS ID: 378368 Before After
VAERS Form:1
Age:0.51
Sex:Male
Location:Michigan
Vaccinated:2010-01-21
Onset:2010-01-21
Submitted:2010-01-26
Entered:2010-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3496AA / 3 - / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3209AA / 1 RL / IJ
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1251Y / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D84740 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0318Y / 3 MO / PO

Administered by: Other      Purchased by: Public
Symptoms: Death, Intensive care, Meningitis, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-26
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 known
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: diagnosis: meningitis.
CDC 'Split Type':

Write-up: upper respiratory complaints - admitted to ICU.

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