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History of Changes from the VAERS Wayback Machine |
First Appeared on 12/8/2009 |
VAERS ID: | 336841 |
VAERS Form: | |
Age: | 0.2 |
Gender: | Female |
Location: | Illinois |
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | C68309 / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC | C68309 / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC | C68309 / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH | C68309 / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 | LL / IM |
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Nasopharyngitis, Pneumonia, Pyrexia, Unresponsive to stimuli, Autopsy, Inflammation
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
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: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 2009-01-09 0000-00-00 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 | - / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Pre-maturity Prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 0000-00-00 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 0 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 0 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 0 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 0 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 0 1 | - MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Vaccinated: | 2008-11-18 |
Onset: | 2008-12-04 |
Submitted: | 0000-00-00 |
Entered: | 2009-01-08 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR | C2956AA / 1 | LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR | UF515AA / 1 | RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR | A0836 / 1 | RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH | C68309 / 1 | LL / IM |
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. | 0641X / 1 | MO / PO |
Administered by: Private Purchased by: Private
Symptoms: Death, Intussusception, Unresponsive to stimuli, Autopsy
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2008-12-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None except runny nose
Preexisting Conditions: Prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient found unresponsive in crib by parents. No symptoms prior - autopsy revealed intussusception. Pronounced dead at ER. 1/23/09 Autopsy report states COD as complications of intussusception. Also states: six areas of IS of small intestine; changes of distant intestine present; early pneumonia; inflammation of lung tissue & small airways. Patient had been found unresponsive in crib after recent history of cold like symptoms with fever.
Link To This Search Result:
http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=336841&WAYBACKHISTORY=ON
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