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This is VAERS ID 858436

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2020

VAERS ID: 858436
VAERS Form:2
Age:0.42
Sex:Male
Location:Florida
Vaccinated:2020-01-09
Onset:2020-01-12
Submitted:0000-00-00
Entered:2020-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ126AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH T81219 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660112 / 2 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER.


Changed on 12/24/2020

VAERS ID: 858436 Before After
VAERS Form:2
Age:0.42
Sex:Male
Location:Florida
Vaccinated:2020-01-09
Onset:2020-01-12
Submitted:0000-00-00
Entered:2020-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ126AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH T81219 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660112 / 2 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER.


Changed on 12/30/2020

VAERS ID: 858436 Before After
VAERS Form:2
Age:0.42
Sex:Male
Location:Florida
Vaccinated:2020-01-09
Onset:2020-01-12
Submitted:0000-00-00
Entered:2020-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ126AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH T81219 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660112 / 2 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER.


Changed on 5/7/2021

VAERS ID: 858436 Before After
VAERS Form:2
Age:0.42
Sex:Male
Location:Florida
Vaccinated:2020-01-09
Onset:2020-01-12
Submitted:0000-00-00
Entered:2020-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ126AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH T81219 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660112 / 2 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER.


Changed on 5/14/2021

VAERS ID: 858436 Before After
VAERS Form:2
Age:0.42
Sex:Male
Location:Florida
Vaccinated:2020-01-09
Onset:2020-01-12
Submitted:0000-00-00
Entered:2020-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ126AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH T81219 / 2 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660112 / 2 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Death, Unresponsive to stimuli, Bed sharing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient expired on 1/12/2020 of unknown cause. Patient was found unresponsive next to his father in father''s bed. Patient was pronounced dead in ER.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=858436&WAYBACKHISTORY=ON


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