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This is VAERS ID 192409

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 192409
VAERS Form:
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / WYETH LABORATORI - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: INFECT, APNEA, SEPSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 12/8/2009

VAERS ID: 192409 Before After
VAERS Form:
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / WYETH LABORATORI WYETH PHARMACEUTICALS, INC - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Apnoea, Infection, Sepsis, INFECT, APNEA, SEPSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 8/31/2010

VAERS ID: 192409 Before After
VAERS Form:
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH - / - - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 9/14/2017

VAERS ID: 192409 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / - UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 2/14/2018

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 6/14/2018

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 8/14/2018

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 9/14/2018

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 10/14/2018

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 12/24/2020

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 12/30/2020

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 5/7/2021

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.


Changed on 5/21/2021

VAERS ID: 192409 Before After
VAERS Form:1
Age:
Sex:Male
Location:West Virginia
Vaccinated:1999-06-25
Onset:1999-06-30
Submitted:2001-09-18
Entered:2002-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Infection, Sepsis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-06-30
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: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ6080218SEP2001

Write-up: A father alleges that his son received a dose of Rota Shield on 6/25/99 and subsequently developed an infection. He was hospitalized where the child died on 6/30/99. The father alleges that his don died as a result of the infection. No further information was available at the date of this report. Death Certificate received on 12/19/2002 indicates respiratory failure and group B strep sepsis as the cause of death.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=192409&WAYBACKHISTORY=ON


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