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This is VAERS ID 857115

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2020

VAERS ID: 857115
VAERS Form:2
Age:1.08
Sex:Female
Location:Montana
Vaccinated:2020-01-14
Onset:2020-01-16
Submitted:0000-00-00
Entered:2020-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ058AB / 4 RL / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6647JA / 1 RL / SYR
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. R013540 / 3 LL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH AL8457 / 1 LL / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-16
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: Acetaminophen (Tylenol) 160 mgi/5mL Solution
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to hospital by EMS, CPR in progress. On arrival, patient had no spontaneous cardiac activity or respirations.


Changed on 12/24/2020

VAERS ID: 857115 Before After
VAERS Form:2
Age:1.08
Sex:Female
Location:Montana
Vaccinated:2020-01-14
Onset:2020-01-16
Submitted:0000-00-00
Entered:2020-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ058AB / 4 RL / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6647JA / 1 RL / SYR
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. R013540 / 3 LL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH AL8457 / 1 LL / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-16
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: Acetaminophen (Tylenol) 160 mgi/5mL Solution
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to hospital by EMS, CPR in progress. On arrival, patient had no spontaneous cardiac activity or respirations.


Changed on 12/30/2020

VAERS ID: 857115 Before After
VAERS Form:2
Age:1.08
Sex:Female
Location:Montana
Vaccinated:2020-01-14
Onset:2020-01-16
Submitted:0000-00-00
Entered:2020-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ058AB / 4 RL / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6647JA / 1 RL / SYR
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. R013540 / 3 LL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH AL8457 / 1 LL / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-16
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: Acetaminophen (Tylenol) 160 mgi/5mL Solution
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to hospital by EMS, CPR in progress. On arrival, patient had no spontaneous cardiac activity or respirations.


Changed on 5/7/2021

VAERS ID: 857115 Before After
VAERS Form:2
Age:1.08
Sex:Female
Location:Montana
Vaccinated:2020-01-14
Onset:2020-01-16
Submitted:0000-00-00
Entered:2020-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ058AB / 4 RL / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6647JA / 1 RL / SYR
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. R013540 / 3 LL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH AL8457 / 1 LL / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-16
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: Acetaminophen (Tylenol) 160 mgi/5mL Solution
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to hospital by EMS, CPR in progress. On arrival, patient had no spontaneous cardiac activity or respirations.


Changed on 5/14/2021

VAERS ID: 857115 Before After
VAERS Form:2
Age:1.08
Sex:Female
Location:Montana
Vaccinated:2020-01-14
Onset:2020-01-16
Submitted:0000-00-00
Entered:2020-01-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ058AB / 4 RL / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT6647JA / 1 RL / SYR
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. R013540 / 3 LL / SYR
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH AL8457 / 1 LL / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-01-16
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: Acetaminophen (Tylenol) 160 mgi/5mL Solution
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient arrived to hospital by EMS, CPR in progress. On arrival, patient had no spontaneous cardiac activity or respirations.

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