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This is VAERS ID 428370

History of Changes from the VAERS Wayback Machine

First Appeared on 8/12/2011

VAERS ID: 428370
VAERS Form:
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 6/14/2014

VAERS ID: 428370 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 4/14/2017

VAERS ID: 428370 Before After
VAERS Form:
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 1 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 9/14/2017

VAERS ID: 428370 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 1 2 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 1 2 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 2/14/2018

VAERS ID: 428370 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 2 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 2 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 6/14/2018

VAERS ID: 428370 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 2 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 2 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 8/14/2018

VAERS ID: 428370 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 2 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 2 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 9/14/2018

VAERS ID: 428370 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 2 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 2 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.


Changed on 10/14/2018

VAERS ID: 428370 Before After
VAERS Form:1
Age:2.0
Sex:Male
Location:Georgia
Vaccinated:2011-06-13
Onset:2011-06-20
Submitted:2011-07-29
Entered:2011-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB509AA / 2 LL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1643Z / 2 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Death, Irritability, Pyrexia, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2011-06-21
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever & fussy 6/20/11. Fever 6/21/11. Found unresponsive after taking a nap.

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