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This is VAERS ID 787241

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2018

VAERS ID: 787241
VAERS Form:2
Age:1.25
Sex:Female
Location:Pennsylvania
Vaccinated:2018-11-15
Onset:2018-11-16
Submitted:0000-00-00
Entered:2018-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 57JT9 / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI906AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH W28770 / 3 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Resuscitation, Unresponsive to stimuli, Autopsy, Drug screen

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-16
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: FTT; plagiocephaly
Allergies: NKDA
Diagnostic Lab Data: Drug screen pending. Autopsy pending
CDC 'Split Type':

Write-up: Patient was found unresponsive in her bed on 11/16/2018 by mom and HH nurse. CPR performed. Patient did not respond. ? possible adverse reaction.


Changed on 12/24/2020

VAERS ID: 787241 Before After
VAERS Form:2
Age:1.25
Sex:Female
Location:Pennsylvania
Vaccinated:2018-11-15
Onset:2018-11-16
Submitted:0000-00-00
Entered:2018-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 57JT9 / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI906AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH W28770 / 3 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Resuscitation, Unresponsive to stimuli, Autopsy, Drug screen

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-16
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: FTT; plagiocephaly
Allergies: NKDA NKDA
Diagnostic Lab Data: Drug screen pending. Autopsy pending
CDC 'Split Type':

Write-up: Patient was found unresponsive in her bed on 11/16/2018 by mom and HH nurse. CPR performed. Patient did not respond. ? possible adverse reaction.


Changed on 12/30/2020

VAERS ID: 787241 Before After
VAERS Form:2
Age:1.25
Sex:Female
Location:Pennsylvania
Vaccinated:2018-11-15
Onset:2018-11-16
Submitted:0000-00-00
Entered:2018-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 57JT9 / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI906AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH W28770 / 3 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Resuscitation, Unresponsive to stimuli, Autopsy, Drug screen

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-16
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: FTT; plagiocephaly
Allergies: NKDA NKDA
Diagnostic Lab Data: Drug screen pending. Autopsy pending
CDC 'Split Type':

Write-up: Patient was found unresponsive in her bed on 11/16/2018 by mom and HH nurse. CPR performed. Patient did not respond. ? possible adverse reaction.


Changed on 5/7/2021

VAERS ID: 787241 Before After
VAERS Form:2
Age:1.25
Sex:Female
Location:Pennsylvania
Vaccinated:2018-11-15
Onset:2018-11-16
Submitted:0000-00-00
Entered:2018-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 57JT9 / 3 RL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UI906AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH W28770 / 3 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Resuscitation, Unresponsive to stimuli, Autopsy, Drug screen

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2018-11-16
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: FTT; plagiocephaly
Allergies: NKDA NKDA
Diagnostic Lab Data: Drug screen pending. Autopsy pending
CDC 'Split Type':

Write-up: Patient was found unresponsive in her bed on 11/16/2018 by mom and HH nurse. CPR performed. Patient did not respond. ? possible adverse reaction.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=787241&WAYBACKHISTORY=ON


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