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This is VAERS ID 415383

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2011

VAERS ID: 415383
VAERS Form:
Age:0.2
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 2/14/2017

VAERS ID: 415383 Before After
VAERS Form:
Age:0.2 0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 9/14/2017

VAERS ID: 415383 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 0 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 2/14/2018

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 6/14/2018

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 8/14/2018

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 9/14/2018

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 10/14/2018

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 12/24/2020

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 12/30/2020

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 5/7/2021

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE


Changed on 5/14/2021

VAERS ID: 415383 Before After
VAERS Form:1
Age:0.18
Sex:Female
Location:Florida
Vaccinated:2010-10-20
Onset:2010-10-21
Submitted:2011-01-25
Entered:2011-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3558AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Unknown      Purchased by: Public
Symptoms: Death, Inappropriate schedule of drug administration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-10-21
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:
Preexisting Conditions: PREMI
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: NONE

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=415383&WAYBACKHISTORY=ON


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