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This is VAERS ID 414262

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2011

VAERS ID: 414262
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 4/13/2011

VAERS ID: 414262 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Pleural disorder, Pulmonary congestion, Pulmonary oedema, Autopsy, Pneumococcal sepsis, Streptococcus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 5/13/2011

VAERS ID: 414262 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Petechiae, Pleural disorder, Pulmonary congestion, Pulmonary oedema, Autopsy, Pneumococcal sepsis, Streptococcus test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 5/13/2013

VAERS ID: 414262 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 6/14/2014

VAERS ID: 414262 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 4/14/2017

VAERS ID: 414262 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 9/14/2017

VAERS ID: 414262 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 2/14/2018

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 6/14/2018

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 8/14/2018

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 9/14/2018

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 10/14/2018

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 12/24/2020

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 12/30/2020

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 5/7/2021

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.


Changed on 5/14/2021

VAERS ID: 414262 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2011-01-03
Onset:2011-01-04
Submitted:2011-01-07
Entered:2011-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3668AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E69593 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0508Z / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-04
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: Unknown
Current Illness: None recorded or verbalized by Mother.
Preexisting Conditions: None recorded or verbalized by Mother
Allergies:
Diagnostic Lab Data: Autopsy.
CDC 'Split Type':

Write-up: To ER. Deceased. Details unavailable. Coroners case. Autopsy performed. Information from Coroner - preliminary shows no cause of death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=414262&WAYBACKHISTORY=ON


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