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This is VAERS ID 406922

History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 406922
VAERS Form:
Age:0.6
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 4/13/2011

VAERS ID: 406922 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Dehydration, Dermatitis diaper, Irritability, Otitis media, Pneumonia aspiration, Scoliosis, Sudden death, Unresponsive to stimuli, Brain oedema, Cardiac disorder, Serratia infection, Serratia test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 5/13/2011

VAERS ID: 406922 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Dehydration, Dermatitis diaper, Irritability, Otitis media, Pneumonia aspiration, Scoliosis, Sudden death, Unresponsive to stimuli, Brain oedema, Cardiac disorder, Serratia infection, Serratia test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 5/13/2013

VAERS ID: 406922 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 6/14/2014

VAERS ID: 406922 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 2/14/2017

VAERS ID: 406922 Before After
VAERS Form:
Age:0.6 0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 4/14/2017

VAERS ID: 406922 Before After
VAERS Form:
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 9/14/2017

VAERS ID: 406922 Before After
VAERS Form:(blank) 1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 2 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 2 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 2/14/2018

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 6/14/2018

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 8/14/2018

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 9/14/2018

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 10/14/2018

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 12/24/2020

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 12/30/2020

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 5/7/2021

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.


Changed on 5/14/2021

VAERS ID: 406922 Before After
VAERS Form:1
Age:0.58
Sex:Female
Location:New Hampshire
Vaccinated:2010-04-30
Onset:2010-05-02
Submitted:2010-11-04
Entered:2010-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3600AA / 3 UN / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 3 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1588Y / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Congenital torticollis, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-05-02
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: SYNERGIS
Current Illness: none
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH11042010

Write-up: Preterm; congenital torticollis presented unresponsive, cardiac arrest.

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