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This is VAERS ID 206350

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 206350
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE 524A2 / - - / RL
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / RL
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - - / RL
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, T1189 / - - / LL
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATO 491178 / - - / LL
RV: ROTAVIRUS (ROTASHIELD) / WYETH LABORATORI 337272 / - - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Coroner ruled SIDS.


Changed on 12/8/2009

VAERS ID: 206350 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS 524A2 / - - RL / RL -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - RL / RL -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - - RL / RL -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, AVENTIS PASTEUR T1189 / - - LL / LL -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATO LEDERLE LABORATORIES 491178 / - - LL / LL -
RV: ROTAVIRUS (ROTASHIELD) / WYETH LABORATORI WYETH PHARMACEUTICALS, INC 337272 / - - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WA031950

Write-up: Coroner ruled SIDS.


Changed on 3/2/2010

VAERS ID: 206350 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / - RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR T1189 / - LL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 491178 / - LL / -
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC 337272 / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 4/7/2010

VAERS ID: 206350 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / - RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR T1189 / - LL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 491178 / - LL / -
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC 337272 / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 8/31/2010

VAERS ID: 206350 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / - RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR T1189 / - LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 491178 / - LL / -
RV: ROTAVIRUS (ROTASHIELD) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 337272 / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 2/14/2017

VAERS ID: 206350 Before After
VAERS Form:
Age:0.2 0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / - RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR T1189 / - LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 491178 / - LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 5/14/2017

VAERS ID: 206350 Before After
VAERS Form:
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / - RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR T1189 / - LL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 491178 / - LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / - - / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 9/14/2017

VAERS ID: 206350 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / - UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / - UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / - UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / - UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / - UNK - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 2/14/2018

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 6/14/2018

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 8/14/2018

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 9/14/2018

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 10/14/2018

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 12/24/2020

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 12/30/2020

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 5/7/2021

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.


Changed on 5/21/2021

VAERS ID: 206350 Before After
VAERS Form:1
Age:0.17
Sex:Female
Location:Washington
Vaccinated:2003-06-18
Onset:0000-00-00
Submitted:2003-06-23
Entered:2003-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS 524A2 / UNK RL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1076L / UNK RL / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR T1189 / UNK LL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 491178 / UNK LL / -
RV: ROTAVIRUS (ROTASHIELD) / PFIZER/WYETH 337272 / UNK MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2003-06-20
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WA031950

Write-up: Coroner ruled SIDS.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=206350&WAYBACKHISTORY=ON


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