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This is VAERS ID 478441

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2013

VAERS ID: 478441
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 5/13/2013

VAERS ID: 478441 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 UN / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 6/14/2014

VAERS ID: 478441 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 3/14/2015

VAERS ID: 478441 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 2/14/2017

VAERS ID: 478441 Before After
VAERS Form:
Age:0.1 0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 9/14/2017

VAERS ID: 478441 Before After
VAERS Form:(blank) 1
Age:0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 0 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 0 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 0 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 2/14/2018

VAERS ID: 478441 Before After
VAERS Form:1
Age:0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 6/14/2018

VAERS ID: 478441 Before After
VAERS Form:1
Age:0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 8/14/2018

VAERS ID: 478441 Before After
VAERS Form:1
Age:0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 9/14/2018

VAERS ID: 478441 Before After
VAERS Form:1
Age:0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.


Changed on 10/14/2018

VAERS ID: 478441 Before After
VAERS Form:1
Age:0.12
Sex:Male
Location:California
Vaccinated:2012-11-29
Onset:2012-12-17
Submitted:2012-12-17
Entered:2012-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4292AA / 1 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR C4357AA / 1 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G10784 / 1 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0036AE / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Feeding disorder of infancy or early childhood, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-17
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: Probiotics
Current Illness: None
Preexisting Conditions: Gassy baby on hypoallergenic formula
Allergies:
Diagnostic Lab Data: Done at medical center
CDC 'Split Type':

Write-up: 12/16/12 baby fed less well. 12/17/12 found unresponsive. Did not respond to resuscitation efforts.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=478441&WAYBACKHISTORY=ON


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