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This is VAERS ID 460000

History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2012

VAERS ID: 460000
VAERS Form:
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS C3947BA / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 2/14/2017

VAERS ID: 460000 Before After
VAERS Form:
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) TDAP (ADACEL) / GLAXOSMITHKLINE BIOLOGICALS SANOFI PASTEUR C3947BA - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 9/14/2017

VAERS ID: 460000 Before After
VAERS Form:(blank) 1
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 2/14/2018

VAERS ID: 460000 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 6/14/2018

VAERS ID: 460000 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 8/14/2018

VAERS ID: 460000 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 9/14/2018

VAERS ID: 460000 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 10/14/2018

VAERS ID: 460000 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.


Changed on 7/14/2019

VAERS ID: 460000 Before After
VAERS Form:1
Age:0.0 (blank)
Sex:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2012-05-01
Submitted:2012-07-24
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Death neonatal, Neonatal disorder, Ultrasound antenatal screen normal, Maternal exposure during pregnancy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-17
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: An "ultrasound 7" was performed and showed no evidence of a defect.
CDC 'Split Type': A0984491B

Write-up: This retrospective pregnancy case was reported by a consumer and described the occurrence of death nos in a female neonate subject who was exposed to BOOSTRIX (GlaxoSmithKline), ADACEL (non-gsk) during pregnancy. A physician or other health care professional has not verified this report. On 6 September 2011, the 31-year-old mother of the subject received unspecified dose of BOOSTRIX (.5 ml, transplacentary) and unspecified dose of ADACEL (transplacentary). The mother''s last menstrual period was on an unknown date and estimated date the delivery was 01 May 2012. The neonate was exposed to BOOSTRIX during an unknown trimester. Examination results of an "ultrasound 7" showed no evidence of a defect. On 1 May 2012, at an unspecified gestation age, the neonate was delivered by unknown method and weight 3.9 kilograms. Apgar score was not provided. The neonate was diagnosed with pulmonary hypertension and arterial venous malformation. The neonate remained hospitalized and died on 17 May 2012, cause of death was not provided. It was unknown whether an autopsy was performed. The outcome of pulmonary hypertension and arterial venous malformation were not specified. Please see report A0984491A for details regarding the mother case. Follow-up information received via the consumer on 17 July 2012 indicated the lot number for BOOSTRIX as C3947BA with expiration date 03 February 2014.

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