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This is VAERS ID 465858

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 465858
VAERS Form:
Age:0.6
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 5/13/2013

VAERS ID: 465858 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 2 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 6/14/2014

VAERS ID: 465858 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 3/14/2015

VAERS ID: 465858 Before After
VAERS Form:
Age:0.6
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 2/14/2017

VAERS ID: 465858 Before After
VAERS Form:
Age:0.6 0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 2 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 9/14/2017

VAERS ID: 465858 Before After
VAERS Form:(blank) 1
Age:0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 2 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 2 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 2 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 2 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 2 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 2/14/2018

VAERS ID: 465858 Before After
VAERS Form:1
Age:0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 6/14/2018

VAERS ID: 465858 Before After
VAERS Form:1
Age:0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 8/14/2018

VAERS ID: 465858 Before After
VAERS Form:1
Age:0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 9/14/2018

VAERS ID: 465858 Before After
VAERS Form:1
Age:0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.


Changed on 10/14/2018

VAERS ID: 465858 Before After
VAERS Form:1
Age:0.62
Sex:Female
Location:North Carolina
Vaccinated:2012-08-28
Onset:2012-08-30
Submitted:2012-09-14
Entered:2012-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4186AA / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0293AE / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0130AE / 3 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1330 / 3 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F63665 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0033AE / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoeic attack, Cyanosis, Death, Intensive care, Multi-organ failure, Unresponsive to stimuli, Brain death, Autopsy, Hypoxic-ischaemic encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-02
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: Recent otitis media - TM''s normal 8/28/12
Allergies:
Diagnostic Lab Data: Extensive evaluation at hospital
CDC 'Split Type':

Write-up: Vaccines given 8/28/12, 850am. Catastrophic event about 6pm 8/30/12. Found by family to be apneic, blue, unresponsive. To ER then to Hosp PICU. Hypoxic ischemic encephalopathy & multisystem organ failure. Brain dead & expired 09/02/12. Law enforcement & DSS notified - autopsy pending. No indication that death related to immunizations.

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