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This is VAERS ID 454855

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/12/2012

VAERS ID: 454855
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 5/13/2013

VAERS ID: 454855 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 6/14/2014

VAERS ID: 454855 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 3/14/2015

VAERS ID: 454855 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 2/14/2017

VAERS ID: 454855 Before After
VAERS Form:
Age:0.3 0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 9/14/2017

VAERS ID: 454855 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 1 2 - MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 2/14/2018

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 6/14/2018

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 8/14/2018

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 9/14/2018

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 10/14/2018

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 12/24/2020

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 12/30/2020

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 5/7/2021

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.


Changed on 5/21/2021

VAERS ID: 454855 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:California
Vaccinated:2012-04-30
Onset:2012-05-01
Submitted:2012-05-02
Entered:2012-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329AB / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH561AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F92472 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB214A / 2 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-01
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: No illness at time of vaccination.
Preexisting Conditions: No pre-existing Physician-Diagnosed Allergies, Birth Defects, or Medical conditions at time of vaccination.
Allergies:
Diagnostic Lab Data: Under investigation
CDC 'Split Type':

Write-up: Unknown, coroner suspected SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=454855&WAYBACKHISTORY=ON


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