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This is VAERS ID 483614

History of Changes from the VAERS Wayback Machine

First Appeared on 2/13/2013

VAERS ID: 483614
VAERS Form:
Age:0.4
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 5/13/2013

VAERS ID: 483614 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 1 LL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 9/17/2013

VAERS ID: 483614 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes." The following information was obtained through follow-up and/or provided by the government. 04/23/13 Coroner''s Report received. Final Cause of Death: Asphyxiation due to Probable Unsafe Sleeping Habits. Found unresponsive at home by parents. An autopsy indicated the cause of death as stated.


Changed on 3/14/2015

VAERS ID: 483614 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes." The following information was obtained through follow-up and/or provided by the government. 04/23/13 Coroner''s Report received. Final Cause of Death: Asphyxiation due to Probable Unsafe Sleeping Habits. Found unresponsive at home by parents. An autopsy indicated the cause of death as stated.


Changed on 2/14/2017

VAERS ID: 483614 Before After
VAERS Form:
Age:0.4 0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 1 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 9/14/2017

VAERS ID: 483614 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 1 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 2/14/2018

VAERS ID: 483614 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 6/14/2018

VAERS ID: 483614 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 8/14/2018

VAERS ID: 483614 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 9/14/2018

VAERS ID: 483614 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."


Changed on 10/14/2018

VAERS ID: 483614 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:South Carolina
Vaccinated:2013-01-18
Onset:0000-00-00
Submitted:2013-01-31
Entered:2013-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B357BB / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 918175 / 2 LL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB305A / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-01-21
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: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No documentation of any problem. Have received word autopsy done - "child died of natural causes."

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