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This is VAERS ID 465936

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 465936
VAERS Form:
Age:0.2
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 0 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER AHBVC022DA / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 5/13/2013

VAERS ID: 465936 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 0 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER AHBVC022DA / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 0 LL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 6/14/2014

VAERS ID: 465936 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 0 LL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER AHBVC022DA / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 8/14/2014

VAERS ID: 465936 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 0 LL / IM
HEP: HEP B (NO BRAND NAME) HEP B (ENGERIX-B) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 2/14/2017

VAERS ID: 465936 Before After
VAERS Form:
Age:0.2 0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 0 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / - RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 0 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 - / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 9/14/2017

VAERS ID: 465936 Before After
VAERS Form:(blank) 1
Age:0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / - UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 0 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 2/14/2018

VAERS ID: 465936 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 1 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 6/14/2018

VAERS ID: 465936 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 1 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 8/14/2018

VAERS ID: 465936 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 1 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 9/14/2018

VAERS ID: 465936 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 1 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"


Changed on 10/14/2018

VAERS ID: 465936 Before After
VAERS Form:1
Age:0.21
Sex:Female
Location:Florida
Vaccinated:2011-12-14
Onset:2011-12-17
Submitted:2012-09-22
Entered:2012-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3840AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC022DA / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916918 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0543AA / 1 MO / PO

Administered by: Unknown      Purchased by: Other
Symptoms: Death, Respiratory arrest, Resuscitation, Sudden infant death syndrome, Autopsy, Musculoskeletal stiffness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-12-17
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: Amoxicillin for upper respiratory infection; Nystatin oral for thrush; Desitin for diaper rash.
Current Illness: Upper respiratory infection; Rectal prolapse; Premature
Preexisting Conditions: Premature; Rectal prolapse; Lactose
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Woke up to baby face up, she looked fine, when I went to pick her up she was stiff still warm, but stiff, and not breathing, called 911 paramedics arrived and tried to resuscitate, she had been dead approx 12 mins. Med ex. said it was SIDS. Autopsy report cause of death "undetermined" manner of death: "undetermined, prematurity by history"

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