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This is VAERS ID 860135

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2020

VAERS ID: 860135
VAERS Form:2
Age:0.17
Sex:Female
Location:Pennsylvania
Vaccinated:2020-01-29
Onset:2020-02-01
Submitted:0000-00-00
Entered:2020-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR UJ230AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS LR537 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH CG9017 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660693 / 1 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-01
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: Omeprazole 2mg
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 2/1/2020 ED diagnosis- cardiac arrest


Changed on 12/24/2020

VAERS ID: 860135 Before After
VAERS Form:2
Age:0.17
Sex:Female
Location:Pennsylvania
Vaccinated:2020-01-29
Onset:2020-02-01
Submitted:0000-00-00
Entered:2020-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR UJ230AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS LR537 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH CG9017 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660693 / 1 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-01
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: Omeprazole 2mg
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 2/1/2020 ED diagnosis- cardiac arrest


Changed on 12/30/2020

VAERS ID: 860135 Before After
VAERS Form:2
Age:0.17
Sex:Female
Location:Pennsylvania
Vaccinated:2020-01-29
Onset:2020-02-01
Submitted:0000-00-00
Entered:2020-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR UJ230AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS LR537 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH CG9017 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660693 / 1 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-01
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: Omeprazole 2mg
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 2/1/2020 ED diagnosis- cardiac arrest


Changed on 5/7/2021

VAERS ID: 860135 Before After
VAERS Form:2
Age:0.17
Sex:Female
Location:Pennsylvania
Vaccinated:2020-01-29
Onset:2020-02-01
Submitted:0000-00-00
Entered:2020-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR UJ230AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS LR537 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH CG9017 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660693 / 1 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-01
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: Omeprazole 2mg
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 2/1/2020 ED diagnosis- cardiac arrest


Changed on 5/14/2021

VAERS ID: 860135 Before After
VAERS Form:2
Age:0.17
Sex:Female
Location:Pennsylvania
Vaccinated:2020-01-29
Onset:2020-02-01
Submitted:0000-00-00
Entered:2020-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR UJ230AA / 1 LL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS LR537 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH CG9017 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1660693 / 1 MO / PO

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-02-01
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: Omeprazole 2mg
Current Illness: GERD
Preexisting Conditions: GERD
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed away on 2/1/2020 ED diagnosis- cardiac arrest

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