National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 419371

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/13/2011

VAERS ID: 419371
VAERS Form:
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 6/14/2014

VAERS ID: 419371 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 4/14/2017

VAERS ID: 419371 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 9/14/2017

VAERS ID: 419371 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 2 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 2 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 2/14/2018

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 6/14/2018

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 8/14/2018

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 9/14/2018

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 10/14/2018

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 12/24/2020

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 12/30/2020

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 5/7/2021

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.


Changed on 5/14/2021

VAERS ID: 419371 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:Illinois
Vaccinated:2011-03-16
Onset:2011-03-17
Submitted:2011-03-23
Entered:2011-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3774AA / 3 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E55587 / 3 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Death, Pulse absent

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-03-17
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: Stuffy nose x 3 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Arrived at hospital ER at 1:59AM pulseless, in asystole.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=419371&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166