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This is VAERS ID 455358

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/12/2012

VAERS ID: 455358
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 0 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 6/14/2014

VAERS ID: 455358 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 0 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 2/14/2017

VAERS ID: 455358 Before After
VAERS Form:
Age:1.0 1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 0 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 4/14/2017

VAERS ID: 455358 Before After
VAERS Form:
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 0 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 0 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 9/14/2017

VAERS ID: 455358 Before After
VAERS Form:(blank) 1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 2 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 0 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 3 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 0 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 2/14/2018

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 6/14/2018

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 8/14/2018

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 9/14/2018

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 10/14/2018

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 12/24/2020

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 12/30/2020

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 5/7/2021

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.


Changed on 5/21/2021

VAERS ID: 455358 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Florida
Vaccinated:2012-03-01
Onset:2012-03-05
Submitted:2012-03-26
Entered:2012-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1531AA / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0872AA / 1 LA / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F18963 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0976AA / 1 RA / SC

Administered by: Public      Purchased by: Public
Symptoms: Death, Autopsy, Toxicologic test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-03-05
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: LOTRIMIN cream BID - Rx written on 3/1/12
Current Illness: None
Preexisting Conditions: Eczema 3/1/12; Tinea corporis 3/1/12
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Pt. died of unknown causes. Autopsy. Toxicology testing in process.

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