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This is VAERS ID 463211

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 463211
VAERS Form:
Age:0.4
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 5/13/2013

VAERS ID: 463211 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 1 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 6/14/2014

VAERS ID: 463211 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 2/14/2017

VAERS ID: 463211 Before After
VAERS Form:
Age:0.4 0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 4/14/2017

VAERS ID: 463211 Before After
VAERS Form:
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 9/14/2017

VAERS ID: 463211 Before After
VAERS Form:(blank) 1
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 1 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 1 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 2/14/2018

VAERS ID: 463211 Before After
VAERS Form:1
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 6/14/2018

VAERS ID: 463211 Before After
VAERS Form:1
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 8/14/2018

VAERS ID: 463211 Before After
VAERS Form:1
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 9/14/2018

VAERS ID: 463211 Before After
VAERS Form:1
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.


Changed on 10/14/2018

VAERS ID: 463211 Before After
VAERS Form:1
Age:0.39
Sex:Female
Location:Alabama
Vaccinated:2012-08-06
Onset:2012-08-15
Submitted:2012-08-17
Entered:2012-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3970AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F30921 / 2 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1540AA / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Intensive care, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-16
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: None
Current Illness: Runny nose; no fever
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 8/15/12 05:51 - presented to ER in full arrest - brought by EMS. Admitted to the PICU with diagnosis of cardiac arrest, respiratory failure.

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