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This is VAERS ID 424958

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2011

VAERS ID: 424958
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:0000-00-00
Submitted:2011-06-08
Entered:2011-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 0 LG / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 0 LG / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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: None
Preexisting Conditions: No prenatal care; Prematurity 32 4/7 wks at birth
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None reported to facility.


Changed on 7/12/2011

VAERS ID: 424958 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06 2011-05-01
Onset:0000-00-00 2011-05-31
Submitted:2011-06-08 2011-06-07
Entered:2011-06-08 2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA C3792AA / 0 1 LG UN / UN IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0979Z / 2 - / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 E63642 / 0 1 LG UN / UN IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z 0205AA / 0 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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: None
Preexisting Conditions: No prenatal care; Prematurity 32 4/7 wks at birth
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NH06071104

Write-up: None reported to facility. Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 8/12/2011

VAERS ID: 424958 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2011-05-01 2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3792AA / 1 UN / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0979Z / 2 0 - UN / - IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E63642 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0205AA / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 9/14/2011

VAERS ID: 424958 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3792AA C3815AA / 1 0 UN / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0979Z / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E63642 915702 / 1 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0205AA 1525Z / 1 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 5/13/2013

VAERS ID: 424958 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 2/14/2017

VAERS ID: 424958 Before After
VAERS Form:
Age:0.2 0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 9/14/2017

VAERS ID: 424958 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 0 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 2/14/2018

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 6/14/2018

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 8/14/2018

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 9/14/2018

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 10/14/2018

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 12/24/2020

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 12/30/2020

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 5/7/2021

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.


Changed on 5/14/2021

VAERS ID: 424958 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2011-04-06
Onset:2011-05-31
Submitted:2011-06-07
Entered:2011-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3815AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 915702 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1525Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Premature baby

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-05-31
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': NH06071104

Write-up: Baby was immunized 4/6/11. Baby was born prematurely. Hep B refused.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=424958&WAYBACKHISTORY=ON


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