National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 422085

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 422085
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 5/13/2013

VAERS ID: 422085 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 6/14/2014

VAERS ID: 422085 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 3/14/2015

VAERS ID: 422085 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 2/14/2017

VAERS ID: 422085 Before After
VAERS Form:
Age:0.2 0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 0 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 9/14/2017

VAERS ID: 422085 Before After
VAERS Form:(blank) 1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 2/14/2018

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 6/14/2018

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 8/14/2018

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 9/14/2018

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 10/14/2018

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 12/24/2020

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 12/30/2020

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 5/7/2021

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.


Changed on 5/14/2021

VAERS ID: 422085 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Arizona
Vaccinated:2011-04-22
Onset:2011-04-24
Submitted:2011-04-29
Entered:2011-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3740AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB960DB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E80081 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1477Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Chest X-ray abnormal, Death, Lung disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-04-24
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: D-VI-SOL 400 u/mL liquid
Current Illness: None known
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest x-ray showed diffuse, hazy, bilateral granular opacities throughout both lungs, worse on the right.
CDC 'Split Type':

Write-up: Death.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=422085&WAYBACKHISTORY=ON


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