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This is VAERS ID 454460

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/12/2012

VAERS ID: 454460
VAERS Form:
Age:0.3
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 0 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 2/14/2017

VAERS ID: 454460 Before After
VAERS Form:
Age:0.3 0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 0 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 0 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 0 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 9/14/2017

VAERS ID: 454460 Before After
VAERS Form:(blank) 1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 0 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 0 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 0 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 2/14/2018

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 6/14/2018

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 8/14/2018

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 9/14/2018

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 10/14/2018

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 12/24/2020

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 12/30/2020

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 5/7/2021

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.


Changed on 5/21/2021

VAERS ID: 454460 Before After
VAERS Form:1
Age:0.34
Sex:Male
Location:Colorado
Vaccinated:2012-03-30
Onset:2012-04-07
Submitted:2012-04-26
Entered:2012-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B315AA / 1 UN / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0958AA / 1 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916977 / 1 UN / UN

Administered by: Public      Purchased by: Public
Symptoms: Hypotonia, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-04-07
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: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Father of baby said baby suddenly went limp and unresponsive, was transported to hospital via ambulance CPR in progress.

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