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This is VAERS ID 483009

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 483009
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 5/13/2013

VAERS ID: 483009 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 9/17/2013

VAERS ID: 483009 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood culture positive, Blood gases, Death, Respiratory disorder, Rib fracture, Sudden infant death syndrome, Bacterial test positive, Enterococcus test positive, Staphylococcus test positive, Streptococcus test positive, Escherichia test positive, Klebsiella test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin The following information was obtained through follow-up and/or provided by the government. 03/18/13 Labs and Diagnostics: Blood Cultures (+) for Escherichia coli, Klebsiella pneumonia, Enterococcus sp, Streptococcus viridians, Staphylococcus aureus. Lung Culture (+) Staph aureus, Strep viridians.
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS. The following information was obtained through follow-up and/or provided by the government. 03/18/13 Autopsy report received. Final Cause of Death: Sudden Infant Death Syndrome (SIDS). Additional Information Abstracted: Anterior Rib Fracture. Old posterior subdural neomembrane, likely subclinical birth-related injury.


Changed on 3/14/2014

VAERS ID: 483009 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood culture positive, Blood gases, Death, Respiratory disorder, Rib fracture, Sudden infant death syndrome, Bacterial test positive, Enterococcus test positive, Staphylococcus test positive, Streptococcus test positive, Escherichia test positive, Klebsiella test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin The following information was obtained through follow-up and/or provided by the government. 03/18/13 Labs and Diagnostics: Blood Cultures (+) for Escherichia coli, Klebsiella pneumonia, Enterococcus sp, Streptococcus viridians, Staphylococcus aureus. Lung Culture (+) Staph aureus, Strep viridians.
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS. The following information was obtained through follow-up and/or provided by the government. 03/18/13 Autopsy report received. Final Cause of Death: Sudden Infant Death Syndrome (SIDS). Additional Information Abstracted: Anterior Rib Fracture. Old posterior subdural neomembrane, likely subclinical birth-related injury.


Changed on 6/14/2014

VAERS ID: 483009 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 3/14/2015

VAERS ID: 483009 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 2/14/2017

VAERS ID: 483009 Before After
VAERS Form:
Age:0.2 0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 9/14/2017

VAERS ID: 483009 Before After
VAERS Form:(blank) 1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / - UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 0 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 0 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 2/14/2018

VAERS ID: 483009 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 6/14/2018

VAERS ID: 483009 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 8/14/2018

VAERS ID: 483009 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 9/14/2018

VAERS ID: 483009 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.


Changed on 10/14/2018

VAERS ID: 483009 Before After
VAERS Form:1
Age:0.18
Sex:Male
Location:New Hampshire
Vaccinated:2012-12-12
Onset:2012-12-31
Submitted:2013-01-30
Entered:2013-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B370BA / UNK LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH549AC / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F72495 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H011458 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Blood bilirubin, Blood gases, Death, Respiratory disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-12-31
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: 10-23-2012 - Nystatin; mouth throat suspension
Current Illness: No
Preexisting Conditions: Twin; Mucocele oral; Neonatal feeding problems 10-18-12 resolved 10-27-2012; History of neonatal hyperbilirubinemia that was resolved on 10-27-2012
Allergies:
Diagnostic Lab Data: Umbilical Vbg; bilirubin
CDC 'Split Type': NH0906201212

Write-up: 12-17-2012 - Acute Respiratory Illness, ? SIDS.

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