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This is VAERS ID 436743

History of Changes from the VAERS Wayback Machine

First Appeared on 10/11/2011

VAERS ID: 436743
VAERS Form:
Age:1.1
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 0 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 7/7/2013

VAERS ID: 436743 Before After
VAERS Form:
Age:1.1
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 0 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 6/14/2014

VAERS ID: 436743 Before After
VAERS Form:
Age:1.1
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 0 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 3/14/2015

VAERS ID: 436743 Before After
VAERS Form:
Age:1.1
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 0 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 2/14/2017

VAERS ID: 436743 Before After
VAERS Form:
Age:1.1 1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 3 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 0 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 9/14/2017

VAERS ID: 436743 Before After
VAERS Form:(blank) 1
Age:1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / - UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 0 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 3 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 0 1 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 2/14/2018

VAERS ID: 436743 Before After
VAERS Form:1
Age:1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 1 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 6/14/2018

VAERS ID: 436743 Before After
VAERS Form:1
Age:1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 1 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 8/14/2018

VAERS ID: 436743 Before After
VAERS Form:1
Age:1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 1 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 9/14/2018

VAERS ID: 436743 Before After
VAERS Form:1
Age:1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 1 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.


Changed on 10/14/2018

VAERS ID: 436743 Before After
VAERS Form:1
Age:1.06
Gender:Male
Location:Minnesota
Vaccinated:2011-09-22
Onset:2011-09-23
Submitted:2011-10-04
Entered:2011-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT4176BA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0404AA / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 916598 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0819AA / 1 LL / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cyanosis, Death, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-09-23
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: Cold/URI/ear infection
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Parents found patient blue and not breathing at home. Code Blue to hospital.

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