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This is VAERS ID 422775

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 422775
VAERS Form:
Age:0.4
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 8/12/2011

VAERS ID: 422775 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematocrit decreased, Haemoglobin decreased, Lymphocyte count increased, Sudden infant death syndrome, Lymphocyte percentage increased, Red cell distribution width increased, Granulocyte percentage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 10/14/2012

VAERS ID: 422775 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Haematocrit decreased, Haemoglobin decreased, Lymphocyte count increased, Sudden infant death syndrome, Lymphocyte percentage increased, Red cell distribution width increased, Granulocyte percentage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 5/13/2013

VAERS ID: 422775 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 2/14/2017

VAERS ID: 422775 Before After
VAERS Form:
Age:0.4 0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 9/14/2017

VAERS ID: 422775 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 0 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 2/14/2018

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 6/14/2018

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 8/14/2018

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 9/14/2018

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 10/14/2018

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 12/24/2020

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 12/30/2020

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 5/7/2021

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 5/21/2021

VAERS ID: 422775 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Alabama
Vaccinated:2011-05-02
Onset:2011-05-12
Submitted:2011-05-12
Entered:2011-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3800AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A15252 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 16602 / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-12
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: 1.)28 week premie twin, sole survivor 2.)survived in utero twin-twin transfusion 3.) apnea medicated in hospital but sent home without any, just an apnea monitor 4.)bilateral hydroceles
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=422775&WAYBACKHISTORY=ON


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