National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 269910

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 269910
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR UT2175CA / 0 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 0 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Death, Influenza like illness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced.


Changed on 12/8/2009

VAERS ID: 269910 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR UT2175CA / 0 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 0 RA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Coma, Death, Influenza like illness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 2/14/2017

VAERS ID: 269910 Before After
VAERS Form:
Age:1.2 1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR UT2175CA / 0 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 0 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma, Death, Influenza like illness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 5/14/2017

VAERS ID: 269910 Before After
VAERS Form:
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 1 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / AVENTIS PASTEUR SANOFI PASTEUR UT2175CA / 0 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 0 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma, Death, Influenza like illness

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 9/14/2017

VAERS ID: 269910 Before After
VAERS Form:(blank) 1
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 0 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 0 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 2/14/2018

VAERS ID: 269910 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 6/14/2018

VAERS ID: 269910 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 8/14/2018

VAERS ID: 269910 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 9/14/2018

VAERS ID: 269910 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.


Changed on 10/14/2018

VAERS ID: 269910 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:2006-12-01
Onset:2006-12-12
Submitted:2006-12-22
Entered:2007-01-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B036AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR UT2175CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 1118F / 1 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2006-12-12
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in bed at end of a nap, unable to resuscitate, went to ER and death pronounced. 4/6/07 Received Autopsy Report which reveals COD as Undetermined. Had flu like symptoms for few days prior to death. Found face down on mattress on floor of nursery in home.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269910&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166