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This is VAERS ID 464200

History of Changes from the VAERS Wayback Machine

First Appeared on 9/12/2012

VAERS ID: 464200
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / - RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 5/13/2013

VAERS ID: 464200 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / - RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / - RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 6/14/2014

VAERS ID: 464200 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / - RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / - RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 3/14/2015

VAERS ID: 464200 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / - RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / - RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Respiratory vomiting issues.~Vaccine not specified (no brand name)~1~0.00~Sibling|Allergies.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 2/14/2017

VAERS ID: 464200 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / - RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / - RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Respiratory Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand name)~1~0.00~Sibling|Allergies.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 9/14/2017

VAERS ID: 464200 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / - UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / - UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / - UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / - UNK - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 2/14/2018

VAERS ID: 464200 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 6/14/2018

VAERS ID: 464200 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 8/14/2018

VAERS ID: 464200 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 9/14/2018

VAERS ID: 464200 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.


Changed on 10/14/2018

VAERS ID: 464200 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Iowa
Vaccinated:2011-07-25
Onset:2011-07-25
Submitted:2012-08-30
Entered:2012-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3895AA / UNK RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0732Z / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916006 / UNK RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0708Z / UNK MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Constipation, Cough, Crying, Death, Irritability, Pyrexia, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-08-11
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: Allergies.~Vaccine not specified (no brand name)~1~0.00~Sibling|Respiratory vomiting issues.~Vaccine not specified (no brand nam
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cough, fussiness, fever, persistent crying, lack of appetite, cough, constipation, death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=464200&WAYBACKHISTORY=ON


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