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This is VAERS ID 406994

History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 406994
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 4/13/2011

VAERS ID: 406994 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 5/13/2011

VAERS ID: 406994 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Asphyxia, Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 6/14/2014

VAERS ID: 406994 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 2/14/2017

VAERS ID: 406994 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
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 reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 4/14/2017

VAERS ID: 406994 Before After
VAERS Form:
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 9/14/2017

VAERS ID: 406994 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 1 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 0 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 2/14/2018

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 6/14/2018

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 8/14/2018

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 9/14/2018

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 10/14/2018

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 12/24/2020

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 12/30/2020

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 5/7/2021

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.


Changed on 5/14/2021

VAERS ID: 406994 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Kentucky
Vaccinated:2010-11-03
Onset:2010-11-04
Submitted:2010-11-06
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 RL / UN
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 04852 / 2 RL / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 914274 / 1 LL / UN

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported or noted
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Child was seen at County Health Center on 110310 for initial immunizations. Child was alert without any problems noted or voiced.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=406994&WAYBACKHISTORY=ON


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