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This is VAERS ID 421334

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 421334
VAERS Form:
Age:0.8
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 UN / UN
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3645AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 7/12/2011

VAERS ID: 421334 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 1 UN / UN
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3645AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 7/7/2013

VAERS ID: 421334 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 UN / UN
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 1 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 2/14/2017

VAERS ID: 421334 Before After
VAERS Form:
Age:0.8 0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 9/14/2017

VAERS ID: 421334 Before After
VAERS Form:(blank) 1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 2 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 1 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 2 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 2/14/2018

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 6/14/2018

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 8/14/2018

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 9/14/2018

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 10/14/2018

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 12/24/2020

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 12/30/2020

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 5/7/2021

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.


Changed on 5/14/2021

VAERS ID: 421334 Before After
VAERS Form:1
Age:0.82
Sex:Male
Location:New Hampshire
Vaccinated:2010-12-09
Onset:2011-01-27
Submitted:2011-04-19
Entered:2011-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3732AA / 3 UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3645AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80083 / 3 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-01-27
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 04192011

Write-up: None stated.

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