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This is VAERS ID 465397

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 465397
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 5/13/2013

VAERS ID: 465397 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 0 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 0 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 6/14/2014

VAERS ID: 465397 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 3/14/2015

VAERS ID: 465397 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 0 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 9/14/2017

VAERS ID: 465397 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 0 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 2/14/2018

VAERS ID: 465397 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 6/14/2018

VAERS ID: 465397 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 8/14/2018

VAERS ID: 465397 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 9/14/2018

VAERS ID: 465397 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.


Changed on 10/14/2018

VAERS ID: 465397 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Missouri
Vaccinated:2012-08-15
Onset:2012-08-16
Submitted:2012-09-04
Entered:2012-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B33CE / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0221AE / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918242 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB288A / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Death, Respiratory arrest, Resuscitation

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: Oral NaCl
Current Illness: Nasal congestion
Preexisting Conditions: Pre-term birth; Hyponatremia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient found at home not breathing, CPR started. EMS continued CPR & brought patient to our ED. Patient still in full cardiopulmonary arrest. Patient never recovered heart rate.

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