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This is VAERS ID 127057

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 127057
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTASHIELD / WYETH - / 0 - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, EEG ABNORM, HEART ARREST, RESPIRAT DIS, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': NONE

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 12/8/2009

VAERS ID: 127057 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-12 1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTASHIELD ROTAVIRUS (ROTASHIELD) / WYETH WYETH PHARMACEUTICALS, INC - / 0 - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome, APNEA, EEG ABNORM, HEART ARREST, RESPIRAT DIS, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': NONE 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 8/31/2010

VAERS ID: 127057 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 5/14/2017

VAERS ID: 127057 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 0 - / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 9/14/2017

VAERS ID: 127057 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 0 1 - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 2/14/2018

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 6/14/2018

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 8/14/2018

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 9/14/2018

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 10/14/2018

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 12/24/2020

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 12/30/2020

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 5/7/2021

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS


Changed on 5/21/2021

VAERS ID: 127057 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:1999-03-11
Onset:1999-03-20
Submitted:1999-07-23
Entered:1999-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / 1 MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Cardiac arrest, Electroencephalogram abnormal, Hypoxia, Respiratory disorder, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-03-21
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: unk
Current Illness: unk
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy: anatomical dx-pulmonary congestion & edema, visceral organ congestion, petechial hemorrhages of the heart, thymus & lungs, hemorrhages of the heart (probable shock changes);respirator lungs, Meckels, diverticulum patent ductus art
CDC 'Split Type': 899211024A

Write-up: pt found unresponsive & not breathing;CPR initiated;pt taken to hosp, CPR was cont & it was determined that some organ function returned;EEG had a near flat wave pattern;placed on ventilator; life support withdrawn 3/21/99; COD: SIDS

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=127057&WAYBACKHISTORY=ON


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