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This is VAERS ID 427623

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History of Changes from the VAERS Wayback Machine

First Appeared on 8/12/2011

VAERS ID: 427623
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 9/14/2011

VAERS ID: 427623 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -
HEP: HEP B (NO BRAND NAME) HEP B (RECOMBIVAX HB) / UNKNOWN MANUFACTURER MERCK & CO. INC. - / 1 RL / - IM
ROT: ROTAVIRUS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / PO
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 10/11/2011

VAERS ID: 427623 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RL / -
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. - 1657Z / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 5/13/2013

VAERS ID: 427623 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 2 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 6/14/2014

VAERS ID: 427623 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 3/14/2015

VAERS ID: 427623 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 2/14/2017

VAERS ID: 427623 Before After
VAERS Form:
Age:0.4 0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 1 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 9/14/2017

VAERS ID: 427623 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 2 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 2 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 1 2 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 2/14/2018

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 6/14/2018

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 8/14/2018

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 9/14/2018

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 10/14/2018

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 12/24/2020

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 12/30/2020

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 5/7/2021

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.


Changed on 5/14/2021

VAERS ID: 427623 Before After
VAERS Form:1
Age:0.36
Sex:Female
Location:Missouri
Vaccinated:2011-06-07
Onset:2011-06-07
Submitted:2011-07-18
Entered:2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C384099 / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH C97564 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1657Z / 2 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Death, Irritability, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I have no idea the manufacturer of the vaccinations.
Current Illness: None
Preexisting Conditions: Lop ear/cup ear. Just cosmetic nothing serious.
Allergies:
Diagnostic Lab Data: Autopsy revealed Re-breathing/SIDS
CDC 'Split Type':

Write-up: Nothing major just fussy, no temperature. She ate somewhat normal, was a little fussy at the breast at times. Didn''t want to be put down.

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