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This is VAERS ID 473737

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2012

VAERS ID: 473737
VAERS Form:
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 5/13/2013

VAERS ID: 473737 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 1 RL / UN
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 2/14/2017

VAERS ID: 473737 Before After
VAERS Form:
Age:0.4 0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 1 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 1 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 9/14/2017

VAERS ID: 473737 Before After
VAERS Form:(blank) 1
Age:0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 1 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 1 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 1 2 - MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 2/14/2018

VAERS ID: 473737 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 6/14/2018

VAERS ID: 473737 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 8/14/2018

VAERS ID: 473737 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 9/14/2018

VAERS ID: 473737 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.


Changed on 10/14/2018

VAERS ID: 473737 Before After
VAERS Form:1
Age:0.35
Sex:Male
Location:Kansas
Vaccinated:2012-05-18
Onset:2012-05-21
Submitted:2012-10-23
Entered:2012-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4221AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F89912 / 2 RL / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1847AA / 2 MO / PO

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-05-21
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died from unknown cause within 3 days of vaccine series. Death deemed SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=473737&WAYBACKHISTORY=ON


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