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This is VAERS ID 459500

History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2012

VAERS ID: 459500
VAERS Form:
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 5/13/2013

VAERS ID: 459500 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 LL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 2/14/2017

VAERS ID: 459500 Before After
VAERS Form:
Age:0.5 0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 1 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 1 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 9/14/2017

VAERS ID: 459500 Before After
VAERS Form:(blank) 1
Age:0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 1 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 1 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 1 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 1 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 2/14/2018

VAERS ID: 459500 Before After
VAERS Form:1
Age:0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 6/14/2018

VAERS ID: 459500 Before After
VAERS Form:1
Age:0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 8/14/2018

VAERS ID: 459500 Before After
VAERS Form:1
Age:0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 9/14/2018

VAERS ID: 459500 Before After
VAERS Form:1
Age:0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.


Changed on 10/14/2018

VAERS ID: 459500 Before After
VAERS Form:1
Age:0.46
Sex:Male
Location:Oregon
Vaccinated:2012-06-27
Onset:2012-06-28
Submitted:2012-07-17
Entered:2012-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4035AA / 2 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH400AA / 2 RL / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G1145 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63667 / 2 LL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1846AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-28
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: Hx of failure to thrive - on NUTRAMIGEN
Allergies:
Diagnostic Lab Data: Autopsy results (P)
CDC 'Split Type':

Write-up: Pt received vaccines 6/27/12 - found dead in crib (prone) next morning.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=459500&WAYBACKHISTORY=ON


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