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This is VAERS ID 384071

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/7/2010

VAERS ID: 384071
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 88183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 8/31/2010

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 88183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 4/13/2011

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood glucose increased, Cardiac arrest, Chest X-ray abnormal, Death, Hyperhidrosis, Hypotonia, Lung infiltration, Mydriasis, Pneumonia viral, Pulse absent, Pupil fixed, Respiratory arrest, Skin warm, Unresponsive to stimuli, Autopsy, Influenza serology negative, Respiratory syncytial virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 5/13/2011

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood glucose increased, Cardiac arrest, Chest X-ray abnormal, Death, Hyperhidrosis, Hypotonia, Lung infiltration, Mydriasis, Pneumonia viral, Pulse absent, Pupil fixed, Respiratory arrest, Skin warm, Unresponsive to stimuli, Autopsy, Influenza serology negative, Respiratory syncytial virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 6/11/2011

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood glucose increased, Cardiac arrest, Chest X-ray abnormal, Death, Hyperhidrosis, Hypotonia, Lung infiltration, Mydriasis, Pneumonia viral, Pulse absent, Pupil fixed, Respiratory arrest, Skin warm, Unresponsive to stimuli, Autopsy, Influenza serology negative, Respiratory syncytial virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 5/13/2013

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
ROTH1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood glucose increased, Cardiac arrest, Chest X-ray abnormal, Death, Hyperhidrosis, Hypotonia, Lung infiltration, Mydriasis, Pneumonia viral, Pulse absent, Pupil fixed, Respiratory arrest, Skin warm, Unresponsive to stimuli, Autopsy, Influenza serology negative, Respiratory syncytial virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 6/14/2014

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood glucose increased, Cardiac arrest, Chest X-ray abnormal, Death, Hyperhidrosis, Hypotonia, Lung infiltration, Mydriasis, Pneumonia viral, Pulse absent, Pupil fixed, Respiratory arrest, Skin warm, Unresponsive to stimuli, Autopsy, Influenza serology negative, Respiratory syncytial virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 3/14/2015

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Blood glucose increased, Cardiac arrest, Chest X-ray abnormal, Death, Hyperhidrosis, Hypotonia, Lung infiltration, Mydriasis, Pneumonia viral, Pulse absent, Pupil fixed, Respiratory arrest, Skin warm, Unresponsive to stimuli, Autopsy, Influenza serology negative, Respiratory syncytial virus test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 2/14/2017

VAERS ID: 384071 Before After
VAERS Form:
Age:0.4 0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 4/14/2017

VAERS ID: 384071 Before After
VAERS Form:
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 9/14/2017

VAERS ID: 384071 Before After
VAERS Form:(blank) 1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 1 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 1 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 1 2 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 2/14/2018

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 6/14/2018

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 8/14/2018

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 9/14/2018

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 10/14/2018

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 12/24/2020

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 12/30/2020

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 5/7/2021

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.


Changed on 5/21/2021

VAERS ID: 384071 Before After
VAERS Form:1
Age:0.36
Sex:Male
Location:Indiana
Vaccinated:2010-02-17
Onset:2010-02-17
Submitted:2010-04-02
Entered:2010-04-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR 3542AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 88183 / 2 RL / IM
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41CB036A / 2 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Death, Respiratory arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2010-02-17
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: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Autopsy
CDC 'Split Type':

Write-up: No symptons,or signs prior to child not breathing. Child taken to ER and CPR was implemented.

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