National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 416893

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2011

VAERS ID: 416893
VAERS Form:
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 0 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 4/13/2011

VAERS ID: 416893 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 0 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Cardiac pacemaker insertion, Cardio-respiratory arrest, Colitis, Crohn's disease, Death, Fatigue, Mydriasis, Peritonitis, Pupil fixed, Respiratory arrest, Staring, Vomiting, Decreased appetite, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 5/13/2011

VAERS ID: 416893 Before After
VAERS Form:
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 0 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 0 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Asthenia, Cardiac pacemaker insertion, Cardio-respiratory arrest, Colitis, Crohn's disease, Death, Fatigue, Mydriasis, Peritonitis, Pupil fixed, Respiratory arrest, Staring, Vomiting, Decreased appetite, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 9/14/2017

VAERS ID: 416893 Before After
VAERS Form:(blank) 1
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 1 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 0 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 2/14/2018

VAERS ID: 416893 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 6/14/2018

VAERS ID: 416893 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 8/14/2018

VAERS ID: 416893 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 9/14/2018

VAERS ID: 416893 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent


Changed on 10/14/2018

VAERS ID: 416893 Before After
VAERS Form:1
Age:3.0
Sex:Female
Location:Colorado
Vaccinated:2011-02-02
Onset:2011-02-07
Submitted:2011-02-15
Entered:2011-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3665AA / 2 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0285Z / 1 RL / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0834Z / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-02-07
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: denied by parent
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: apparently found dead in bed by parent

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=416893&WAYBACKHISTORY=ON


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