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This is VAERS ID 458862

History of Changes from the VAERS Wayback Machine

First Appeared on 7/13/2012

VAERS ID: 458862
VAERS Form:
Age:1.1
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 6/14/2014

VAERS ID: 458862 Before After
VAERS Form:
Age:1.1
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 2/14/2017

VAERS ID: 458862 Before After
VAERS Form:
Age:1.1 1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 4/14/2017

VAERS ID: 458862 Before After
VAERS Form:
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 3 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 9/14/2017

VAERS ID: 458862 Before After
VAERS Form:(blank) 1
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 3 4 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 2/14/2018

VAERS ID: 458862 Before After
VAERS Form:1
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 4 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 6/14/2018

VAERS ID: 458862 Before After
VAERS Form:1
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 4 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 8/14/2018

VAERS ID: 458862 Before After
VAERS Form:1
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 4 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 9/14/2018

VAERS ID: 458862 Before After
VAERS Form:1
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 4 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.


Changed on 10/14/2018

VAERS ID: 458862 Before After
VAERS Form:1
Age:1.11
Sex:Female
Location:Unknown
Vaccinated:2011-04-27
Onset:2011-08-28
Submitted:2012-05-22
Entered:2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3747AB / 4 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Aspiration, Choking, Death, Respiratory arrest, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: MMR, other mfr, D1, 01/JUL/2011
Current Illness:
Preexisting Conditions: The patient had dose one, two and three of PENTACEL on 20 May 2010, 22 July 2010 and 23 September 2010 respectively. The lot number for dose one was C3556AA and the lot number for dose two and three was C3634AA.
Allergies:
Diagnostic Lab Data: Not reported
CDC 'Split Type': 201109818

Write-up: Initial report was received on 12 October 2011 from an investigator participating in the study under the reference number M5A11. A 17 month-old female patient with no reported past medical history experienced respiratory arrest due to aspiration (resulting from vomiting) 123 days after receiving dose four of PENTACEL, lot number C3747AB (route and site of administration not reported) on 27 April 2011. Additional vaccine history included a first dose of MMR, lot number 1644Z (route and site of administration not reported) received on 01 July 2011. According to the investigator, a representative from the coroner''s office was told that the "child likely choked on a ravioli as fed by a parent". No autopsy was performed as it was not a coroner''s case. The outcome was fatal. According to the investigator, the event was not related to the trial product. Documents held by sender: none.

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