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This is VAERS ID 906303

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 906303
VAERS Form:2
Age:0.58
Sex:Female
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ350AA / UNK RL / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS DE7TB / UNK LL / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 4CL44 / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH D12971 / UNK LL / IM

Administered by: Public      Purchased by: ??
Symptoms: Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-18
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: Tylenol
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: body sent for autopsy
CDC 'Split Type':

Write-up: unknown if adverse effect, parents found baby unresponsive and blue and called 911 and CPR started and baby expired unknown cause


Changed on 12/30/2020

VAERS ID: 906303 Before After
VAERS Form:2
Age:0.58
Sex:Female
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ350AA / UNK RL / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS DE7TB / UNK LL / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 4CL44 / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH D12971 / UNK LL / IM

Administered by: Public      Purchased by: ??
Symptoms: Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-18
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: Tylenol
Current Illness: none
Preexisting Conditions: unknown
Allergies: none none
Diagnostic Lab Data: body sent for autopsy
CDC 'Split Type':

Write-up: unknown if adverse effect, parents found baby unresponsive and blue and called 911 and CPR started and baby expired unknown cause


Changed on 5/7/2021

VAERS ID: 906303 Before After
VAERS Form:2
Age:0.58
Sex:Female
Location:North Carolina
Vaccinated:2020-12-17
Onset:2020-12-18
Submitted:0000-00-00
Entered:2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR UJ350AA / UNK RL / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS DE7TB / UNK LL / -
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 4CL44 / UNK RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH D12971 / UNK LL / IM

Administered by: Public      Purchased by: ??
Symptoms: Cyanosis, Death, Resuscitation, Unresponsive to stimuli, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-18
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: Tylenol
Current Illness: none
Preexisting Conditions: unknown
Allergies: none none
Diagnostic Lab Data: body sent for autopsy
CDC 'Split Type':

Write-up: unknown if adverse effect, parents found baby unresponsive and blue and called 911 and CPR started and baby expired unknown cause

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906303&WAYBACKHISTORY=ON


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