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This is VAERS ID 459685

History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2012

VAERS ID: 459685
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F56178 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 10/14/2012

VAERS ID: 459685 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F56178 / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 5/13/2013

VAERS ID: 459685 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 6/14/2014

VAERS ID: 459685 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 2/14/2017

VAERS ID: 459685 Before After
VAERS Form:
Age:0.2 0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 4/14/2017

VAERS ID: 459685 Before After
VAERS Form:
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 9/14/2017

VAERS ID: 459685 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 1 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 2/14/2018

VAERS ID: 459685 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 6/14/2018

VAERS ID: 459685 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 8/14/2018

VAERS ID: 459685 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 9/14/2018

VAERS ID: 459685 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.


Changed on 10/14/2018

VAERS ID: 459685 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Arkansas
Vaccinated:2012-06-29
Onset:2012-06-30
Submitted:2012-07-19
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4195AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC044AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CBZ68A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-06-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: born 5 weeks premature
Allergies:
Diagnostic Lab Data: Autopsy to be performed. Hospital records will be sent to VAERS via regular mail.
CDC 'Split Type': AR1216

Write-up: Found unresponsive by parents just after midnight 6/30/12, transported to local hospital with external CPR by EMS. ER able to intubate and establish HR, then transferred to another hospital. Died at 2148 on 6/30/12.

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