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This is VAERS ID 795791

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2019

VAERS ID: 795791
VAERS Form:2
Age:0.75
Sex:Male
Location:South Carolina
Vaccinated:2019-01-10
Onset:2019-01-10
Submitted:0000-00-00
Entered:2019-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6259MA / 1 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Body temperature decreased, Cardiac arrest, Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-01-10
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: None known
Current Illness: Upper respiratory illness
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Blood glucose noted in ED record
CDC 'Split Type':

Write-up: Per ER report, patient received his Flu vaccine at his 9 month well check. Parents took him home. He fed and then went down for a nap. One to two hours later mother reports finding the child cyanotic and unresponsive. EMS called and found him in asystole. EMS attempted resuscitation en route to ER by placing IO and attempted intubation. He was given epinephrine x 2. CPR continued in the ED. Warmed to 35.4, intubated with 3.5 cuffed ET and received multiple rounds of epinephrine. Chest compressions were recorded for 18 minutes. Time of death was called at 1814.


Changed on 12/24/2020

VAERS ID: 795791 Before After
VAERS Form:2
Age:0.75
Sex:Male
Location:South Carolina
Vaccinated:2019-01-10
Onset:2019-01-10
Submitted:0000-00-00
Entered:2019-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6259MA / 1 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Body temperature decreased, Cardiac arrest, Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-01-10
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: None known
Current Illness: Upper respiratory illness
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data: Blood glucose noted in ED record
CDC 'Split Type':

Write-up: Per ER report, patient received his Flu vaccine at his 9 month well check. Parents took him home. He fed and then went down for a nap. One to two hours later mother reports finding the child cyanotic and unresponsive. EMS called and found him in asystole. EMS attempted resuscitation en route to ER by placing IO and attempted intubation. He was given epinephrine x 2. CPR continued in the ED. Warmed to 35.4, intubated with 3.5 cuffed ET and received multiple rounds of epinephrine. Chest compressions were recorded for 18 minutes. Time of death was called at 1814.


Changed on 12/30/2020

VAERS ID: 795791 Before After
VAERS Form:2
Age:0.75
Sex:Male
Location:South Carolina
Vaccinated:2019-01-10
Onset:2019-01-10
Submitted:0000-00-00
Entered:2019-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6259MA / 1 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Body temperature decreased, Cardiac arrest, Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-01-10
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: None known
Current Illness: Upper respiratory illness
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data: Blood glucose noted in ED record
CDC 'Split Type':

Write-up: Per ER report, patient received his Flu vaccine at his 9 month well check. Parents took him home. He fed and then went down for a nap. One to two hours later mother reports finding the child cyanotic and unresponsive. EMS called and found him in asystole. EMS attempted resuscitation en route to ER by placing IO and attempted intubation. He was given epinephrine x 2. CPR continued in the ED. Warmed to 35.4, intubated with 3.5 cuffed ET and received multiple rounds of epinephrine. Chest compressions were recorded for 18 minutes. Time of death was called at 1814.


Changed on 5/7/2021

VAERS ID: 795791 Before After
VAERS Form:2
Age:0.75
Sex:Male
Location:South Carolina
Vaccinated:2019-01-10
Onset:2019-01-10
Submitted:0000-00-00
Entered:2019-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6259MA / 1 LL / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood glucose, Body temperature decreased, Cardiac arrest, Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2019-01-10
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: None known
Current Illness: Upper respiratory illness
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data: Blood glucose noted in ED record
CDC 'Split Type':

Write-up: Per ER report, patient received his Flu vaccine at his 9 month well check. Parents took him home. He fed and then went down for a nap. One to two hours later mother reports finding the child cyanotic and unresponsive. EMS called and found him in asystole. EMS attempted resuscitation en route to ER by placing IO and attempted intubation. He was given epinephrine x 2. CPR continued in the ED. Warmed to 35.4, intubated with 3.5 cuffed ET and received multiple rounds of epinephrine. Chest compressions were recorded for 18 minutes. Time of death was called at 1814.

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