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This is VAERS ID 428369

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History of Changes from the VAERS Wayback Machine

First Appeared on 8/12/2011

VAERS ID: 428369
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 5/13/2013

VAERS ID: 428369 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 2/14/2017

VAERS ID: 428369 Before After
VAERS Form:
Age:0.2 0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 9/14/2017

VAERS ID: 428369 Before After
VAERS Form:(blank) 1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 2/14/2018

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 6/14/2018

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 8/14/2018

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 9/14/2018

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 10/14/2018

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 12/24/2020

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 12/30/2020

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 5/7/2021

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.


Changed on 5/14/2021

VAERS ID: 428369 Before After
VAERS Form:1
Age:0.23
Sex:Male
Location:Tennessee
Vaccinated:2011-07-25
Onset:2011-07-26
Submitted:2011-07-28
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3852AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1519Z / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916007 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1199Z / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Passive smoking, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-07-26
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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Mom awoke in am to find baby unresponsive. EMS initiated CPR. No response & pronounced in ED. Associated risk factors: bed-sharing, maternal smoking. Autopsy pending.

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