National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 379119

History of Changes from the VAERS Wayback Machine

First Appeared on 2/5/2010

VAERS ID: 379119
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:0000-00-00
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 3/2/2010

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:0000-00-00 2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 4/7/2010

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 8/31/2010

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 4/13/2011

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Visceral congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 5/13/2011

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Visceral congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 6/11/2011

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Visceral congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 5/13/2013

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Visceral congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 6/14/2014

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Visceral congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 3/14/2015

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Visceral congestion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 2/14/2017

VAERS ID: 379119 Before After
VAERS Form:
Age:0.2 0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 4/14/2017

VAERS ID: 379119 Before After
VAERS Form:
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 9/14/2017

VAERS ID: 379119 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 0 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / - UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 0 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 2/14/2018

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 6/14/2018

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 8/14/2018

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 9/14/2018

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 10/14/2018

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 12/24/2020

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.


Changed on 12/30/2020

VAERS ID: 379119 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:Florida
Vaccinated:2010-01-13
Onset:2010-01-30
Submitted:2010-02-02
Entered:2010-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3261AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBHB730AA / UNK RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH D48928 / 1 RL / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41DA802A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-01-30
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: NYSTATIN oral soln.
Current Illness: Thrush
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=379119&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166