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This is VAERS ID 485434

History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2013

VAERS ID: 485434
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 4/13/2013

VAERS ID: 485434 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) HEP B (ENGERIX-B) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS - AHBVC188CA / 0 UN LL / UN IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 9/17/2013

VAERS ID: 485434 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 0 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Cerebral infarction, Death, Epistaxis, Haemorrhage intracranial, Mouth haemorrhage, Pulse absent, Respiratory arrest, Resuscitation, Rib fracture, Sudden death, Unresponsive to stimuli, Face injury, Encephalomalacia, Toxicologic test abnormal, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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: The following information was obtained through follow-up and/or provided by the government. 02/26/13: Perirectal abscess, Rx Bactrim.
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted The following information was obtained through follow-up and/or provided by the government. 5/21/13 Autopsy Toxicology Report - Heart Blood Caffeine (+).
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin. The following information was obtained through follow-up and/or provided by the government. 02/26/13 ER records received. Service date 02/10/13. Diagnosis: Sudden Death. Infant found unresponsive by parent. Arrived with CPR in progress. Visble trauma, injury to face, blood around mouth and nose. Asystole. No spontaneous pulse, no respirations, resuscitation terminated, medical examiner contacted. 5/21/13 Autopsy report received. Final Cause of Death: Undetermined cause of death, may represent a natural death from Sudden Infant Death Syndrome (SIDS) or seizures/apnea related to prenatal/perinatal cerebral infacts, it is not possible to exclude accidental asphyxia resulting from the dangerous sleep environment. Additional Information Abstracted: Fractures of right anterior ribs consistent with chest compressions during CPR. Co-sleeping. Cystic encephalomalacia consistent with prenatal or perinatal infarcts, Right occipital epidural hemorrhage.


Changed on 3/14/2015

VAERS ID: 485434 Before After
VAERS Form:
Age:0.0
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 0 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Cerebral infarction, Death, Epistaxis, Haemorrhage intracranial, Mouth haemorrhage, Pulse absent, Respiratory arrest, Resuscitation, Rib fracture, Sudden death, Unresponsive to stimuli, Face injury, Encephalomalacia, Toxicologic test abnormal, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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: The following information was obtained through follow-up and/or provided by the government. 02/26/13: Perirectal abscess, Rx Bactrim.
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted The following information was obtained through follow-up and/or provided by the government. 5/21/13 Autopsy Toxicology Report - Heart Blood Caffeine (+).
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin. The following information was obtained through follow-up and/or provided by the government. 02/26/13 ER records received. Service date 02/10/13. Diagnosis: Sudden Death. Infant found unresponsive by parent. Arrived with CPR in progress. Visble trauma, injury to face, blood around mouth and nose. Asystole. No spontaneous pulse, no respirations, resuscitation terminated, medical examiner contacted. 5/21/13 Autopsy report received. Final Cause of Death: Undetermined cause of death, may represent a natural death from Sudden Infant Death Syndrome (SIDS) or seizures/apnea related to prenatal/perinatal cerebral infacts, it is not possible to exclude accidental asphyxia resulting from the dangerous sleep environment. Additional Information Abstracted: Fractures of right anterior ribs consistent with chest compressions during CPR. Co-sleeping. Cystic encephalomalacia consistent with prenatal or perinatal infarcts, Right occipital epidural hemorrhage.


Changed on 2/14/2017

VAERS ID: 485434 Before After
VAERS Form:
Age:0.0 0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 0 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 9/14/2017

VAERS ID: 485434 Before After
VAERS Form:(blank) 1
Age:0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 0 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 2/14/2018

VAERS ID: 485434 Before After
VAERS Form:1
Age:0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 6/14/2018

VAERS ID: 485434 Before After
VAERS Form:1
Age:0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 8/14/2018

VAERS ID: 485434 Before After
VAERS Form:1
Age:0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 9/14/2018

VAERS ID: 485434 Before After
VAERS Form:1
Age:0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.


Changed on 10/14/2018

VAERS ID: 485434 Before After
VAERS Form:1
Age:0.01
Sex:Male
Location:New Hampshire
Vaccinated:2013-01-02
Onset:2013-02-10
Submitted:2013-02-25
Entered:2013-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC188CA / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-02-10
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:
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data: None noted
CDC 'Split Type': NH02112013

Write-up: Born at 39 weeks gestation. Newborn screenings WNL. May have been a twin.

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