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This is VAERS ID 418984

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/13/2011

VAERS ID: 418984
VAERS Form:
Age:0.2
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / 0 UN / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 0 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 5/13/2011

VAERS ID: 418984 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - C3773AA / 0 UN / UN IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS - AHBVB97 / - 0 UN / UN IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - 0917Z / 0 UN - / UN PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 5/13/2013

VAERS ID: 418984 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 6/14/2014

VAERS ID: 418984 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 2/14/2017

VAERS ID: 418984 Before After
VAERS Form:
Age:0.2 0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 4/14/2017

VAERS ID: 418984 Before After
VAERS Form:
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 0 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 9/14/2017

VAERS ID: 418984 Before After
VAERS Form:(blank) 1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 0 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 0 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 2/14/2018

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 6/14/2018

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 8/14/2018

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 9/14/2018

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 10/14/2018

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 12/24/2020

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 12/30/2020

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 5/7/2021

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.


Changed on 5/14/2021

VAERS ID: 418984 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Virginia
Vaccinated:2011-02-16
Onset:0000-00-00
Submitted:2011-03-11
Entered:2011-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3773AA / 1 UN / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB97 / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915704 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0917Z / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-23
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
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=418984&WAYBACKHISTORY=ON


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