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This is VAERS ID 460006

History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2012

VAERS ID: 460006
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 5/13/2013

VAERS ID: 460006 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 0 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 2/14/2017

VAERS ID: 460006 Before After
VAERS Form:
Age:0.2 0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 0 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 0 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 9/14/2017

VAERS ID: 460006 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 0 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 1 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 0 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 2/14/2018

VAERS ID: 460006 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 6/14/2018

VAERS ID: 460006 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 8/14/2018

VAERS ID: 460006 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 9/14/2018

VAERS ID: 460006 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.


Changed on 10/14/2018

VAERS ID: 460006 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:New Hampshire
Vaccinated:2012-06-07
Onset:2012-06-28
Submitted:2012-07-18
Entered:2012-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4190AA / 1 LL / UN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC093AA / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F53376 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1710AA / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: See attached
CDC 'Split Type': NH072420128

Write-up: 6/28 - Pt. rushed to ER in cardiac arrest.

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