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This is VAERS ID 490225

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2013

VAERS ID: 490225
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 9/17/2013

VAERS ID: 490225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful. The following information was obtained through follow-up and/or provided by the government. 9/4/13 Death Certificate Received. Final Cause of Death: Undetermined.


Changed on 3/14/2015

VAERS ID: 490225 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful. The following information was obtained through follow-up and/or provided by the government. 9/4/13 Death Certificate Received. Final Cause of Death: Undetermined.


Changed on 2/14/2017

VAERS ID: 490225 Before After
VAERS Form:
Age:0.3 0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 1 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 9/14/2017

VAERS ID: 490225 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 1 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 1 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 1 2 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 2/14/2018

VAERS ID: 490225 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 6/14/2018

VAERS ID: 490225 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 8/14/2018

VAERS ID: 490225 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 9/14/2018

VAERS ID: 490225 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.


Changed on 10/14/2018

VAERS ID: 490225 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Arizona
Vaccinated:2013-03-26
Onset:2013-03-29
Submitted:2013-04-25
Entered:2013-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4357AA / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. M014756 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH G73024 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. H019492 / 2 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-03-29
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: None
Current Illness: None
Preexisting Conditions: Bronchiolitis-02/08/13
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found unresponsive in crib at daycare. Resuscitative efforts unsuccessful.

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