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This is VAERS ID 252079

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 252079
VAERS Form:
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. C0947AA / - UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. W0197 / - UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infan
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with oth"er recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W0


Changed on 12/8/2009

VAERS ID: 252079 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR C0947AA / - UN / -
HEPA: HEP A (VAQTA) HEP A (VAQTA) / MERCK & CO. INC. 0498N / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR W0197 / - UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / - UN / -
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infan Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with oth"er other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W0 W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 5/14/2017

VAERS ID: 252079 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / AVENTIS PASTEUR SANOFI PASTEUR C0947AA / - UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / - UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR W0197 / - UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / - UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 9/14/2017

VAERS ID: 252079 Before After
VAERS Form:(blank) 1
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / - UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / - UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / - UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / - UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / - UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 2/14/2018

VAERS ID: 252079 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 6/14/2018

VAERS ID: 252079 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 8/14/2018

VAERS ID: 252079 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 9/14/2018

VAERS ID: 252079 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss


Changed on 10/14/2018

VAERS ID: 252079 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Unknown
Vaccinated:2003-05-13
Onset:0000-00-00
Submitted:2006-01-12
Entered:2006-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C0947AA / UNK UN / -
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0498N / UNK UN / -
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR W0197 / UNK UN / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0858M / UNK UN / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0485N / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Neoplasm, Neoplasm malignant

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: The subject had a history of renal failure and pancytopenia. The subject received the following vaccines in addition to vaccines listed in the product section. 1/8/2001 first dose of Infanrix, lot number 970A2, 3/8/2001 second dose of Infanrix, lot number 979A2, 9/20/2001 third dose of Infanrix lot number 506A2.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200500901

Write-up: The subject is a female with the date of birth of 10/18/2000, who expired due to cancer while enrolled in a comparative post marketing safety study of Daptacel (Diphtheria and Tetanus toxoids and Acellular pertussis vaccine absorbed) administered with other recommended vaccines according to standard of care at 2, 4, and 6 months of age in infants and as a booster to toddlers. The subject received the study vaccine on 5/13/2003. Other vaccines administered on that day included a dose of IPOL, lot number W01972, a dose of hepatitis A vaccine, lot number 0498N, a dose of MMR/measles, mumps and rubella vaccine, lot number 0858M, and a dose of VZV, lot number 0485N, manufacturer unknown. The routes and sited of administration were not provided. The subject suffered from a germ cell tumor. The tumor was resected and radiotherapy and chemotherapy were started. The subject was in palliative care when she expired 398 days post immunization. The subject did have a history of renal failure and pancytopenia. Autopsy information is pending. The event of cancer was reported by the investigator as unrelated to the study vaccine. 3/7/06 Multiple d/c summaries received which state patient had abdominal teratoma w/metastasis/ss

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