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This is VAERS ID 421048

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 421048
VAERS Form:
Age:1.5
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3566BA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 7/12/2011

VAERS ID: 421048 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 LL / IM
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3566BA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 7/7/2013

VAERS ID: 421048 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 6/14/2014

VAERS ID: 421048 Before After
VAERS Form:
Age:1.5
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 2/14/2017

VAERS ID: 421048 Before After
VAERS Form:
Age:1.5 1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications:
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 4/14/2017

VAERS ID: 421048 Before After
VAERS Form:
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 9/14/2017

VAERS ID: 421048 Before After
VAERS Form:(blank) 1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 0 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 2/14/2018

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 6/14/2018

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 8/14/2018

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 9/14/2018

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 10/14/2018

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 12/24/2020

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 12/30/2020

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 5/7/2021

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.


Changed on 5/14/2021

VAERS ID: 421048 Before After
VAERS Form:1
Age:1.51
Sex:Female
Location:California
Vaccinated:2010-10-15
Onset:2010-11-08
Submitted:2011-04-14
Entered:2011-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3566BA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB444BA / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-11-08
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: None~ ()~~0.00~Patient|None~ ()~~0.00~Sibling
Other Medications: none
Current Illness: none
Preexisting Conditions: H/O possible febrile seizure 2/2010.
Allergies:
Diagnostic Lab Data: 7 above, per medical examiner report.
CDC 'Split Type':

Write-up: Sudden unexplained death.

New Search

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=421048&WAYBACKHISTORY=ON


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