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This is VAERS ID 463731

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 463731
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UH432AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 5/13/2013

VAERS ID: 463731 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 UN / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UH432AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 UN / UN
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 3/14/2014

VAERS ID: 463731 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 UN / IM
HIBV: HIB (NO BRAND NAME) HIB (ACTHIB) / UNKNOWN MANUFACTURER SANOFI PASTEUR UH432AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 UN / UN IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 6/14/2014

VAERS ID: 463731 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 3/14/2015

VAERS ID: 463731 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 2/14/2017

VAERS ID: 463731 Before After
VAERS Form:
Age:0.4 0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 9/14/2017

VAERS ID: 463731 Before After
VAERS Form:(blank) 1
Age:0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 1 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 1 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 1 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 2/14/2018

VAERS ID: 463731 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 6/14/2018

VAERS ID: 463731 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 8/14/2018

VAERS ID: 463731 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 9/14/2018

VAERS ID: 463731 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.


Changed on 10/14/2018

VAERS ID: 463731 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:New Hampshire
Vaccinated:2012-07-11
Onset:2012-08-25
Submitted:2012-08-31
Entered:2012-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B329BA / 2 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH432AA / 2 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F56178 / 2 UN / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB268A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-08-25
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: No
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC 'Split Type': NH08312012

Write-up: Well child exam on 7-11-12. No problems at birth.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=463731&WAYBACKHISTORY=ON


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