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This is VAERS ID 466326

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2012

VAERS ID: 466326
VAERS Form:
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 0 - / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 7/7/2013

VAERS ID: 466326 Before After
VAERS Form:
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 0 - / IN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 0 - / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 6/14/2014

VAERS ID: 466326 Before After
VAERS Form:
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 0 - / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 3/14/2015

VAERS ID: 466326 Before After
VAERS Form:
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 0 - / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 9/14/2017

VAERS ID: 466326 Before After
VAERS Form:(blank) 1
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 0 1 - NS / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 2/14/2018

VAERS ID: 466326 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 6/14/2018

VAERS ID: 466326 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 8/14/2018

VAERS ID: 466326 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 9/14/2018

VAERS ID: 466326 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.


Changed on 10/14/2018

VAERS ID: 466326 Before After
VAERS Form:1
Age:3.0
Sex:Male
Location:Maryland
Vaccinated:2012-09-10
Onset:2012-09-14
Submitted:2012-09-25
Entered:2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2140 / 1 NS / IN

Administered by: Unknown      Purchased by: Public
Symptoms: Intensive care, Nasopharyngitis, Respiratory arrest, Influenza virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-09-20
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: Miralax; Dulcolax; Erythromycin (EES); Iron; Poly-Vi-Sol; Lactulose
Current Illness: Mild URI for 1 day with no fever and no respiratory distress
Preexisting Conditions: Prematurity (31-32 weeks); G-tube dependent; Developmental delay; Atrial Septal Defect; Undiagnosed cause for muscle weakness; Constipation
Allergies:
Diagnostic Lab Data: Negative Influenza test result.
CDC 'Split Type':

Write-up: Respiratory arrest at home after 4 days of worsening cold symptoms. Driven by family auto to Medical Center and then transfered to PICU at another hospital.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=466326&WAYBACKHISTORY=ON


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