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This is VAERS ID 481268

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 481268
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 6/12/2013

VAERS ID: 481268 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 0 LL / IM
DTPPHIB: DTP + IPV + ACT-HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RL / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 0 LL / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / PO
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 0 RL / IM
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 0 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 6/14/2014

VAERS ID: 481268 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 0 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 3/14/2015

VAERS ID: 481268 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 0 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 2/14/2017

VAERS ID: 481268 Before After
VAERS Form:
Age:0.3 0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 0 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 0 - / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 9/14/2017

VAERS ID: 481268 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 0 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 0 1 - MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 2/14/2018

VAERS ID: 481268 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 1 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 6/14/2018

VAERS ID: 481268 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 1 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 8/14/2018

VAERS ID: 481268 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 1 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 9/14/2018

VAERS ID: 481268 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 1 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.


Changed on 10/14/2018

VAERS ID: 481268 Before After
VAERS Form:1
Age:0.33
Sex:Female
Location:Florida
Vaccinated:2013-01-10
Onset:2013-01-11
Submitted:2013-01-14
Entered:2013-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370AA / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H015034 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F18876 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H016902 / 1 MO / PO

Administered by: Unknown      Purchased by: Private
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-11
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: Tylenol
Current Illness: None known
Preexisting Conditions: Trisomy 18, clean bill of health from open heart surgery
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: None.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=481268&WAYBACKHISTORY=ON


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