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This is VAERS ID 432687

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2011

VAERS ID: 432687
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / - - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / - - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 6/14/2014

VAERS ID: 432687 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / - - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / - - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 2/14/2017

VAERS ID: 432687 Before After
VAERS Form:
Age:0.4 0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / - - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 1 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / - - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 9/14/2017

VAERS ID: 432687 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / - UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 1 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / - UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 2/14/2018

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 6/14/2018

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 8/14/2018

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 9/14/2018

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 10/14/2018

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 12/24/2020

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 12/30/2020

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 5/7/2021

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage


Changed on 5/14/2021

VAERS ID: 432687 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:California
Vaccinated:2011-07-25
Onset:0000-00-00
Submitted:2011-09-01
Entered:2011-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3931AA / UNK - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0491AA / 2 - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 916598 / UNK - / -

Administered by: Unknown      Purchased by: Other
Symptoms: Pyrexia, Retinal haemorrhage, Subdural haematoma, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-12
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? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: baby Tylenol, baby Orajel
Current Illness: Cold
Preexisting Conditions: Zithromax
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: fever, vomiting, subdural hematoma, retinal hemorrhage

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