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This is VAERS ID 459641

History of Changes from the VAERS Wayback Machine

First Appeared on 8/13/2012

VAERS ID: 459641
VAERS Form:
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 2 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 0 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 0 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 0 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 0 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 9/14/2017

VAERS ID: 459641 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 2 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 0 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 0 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 0 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 0 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 2/14/2018

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 6/14/2018

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 8/14/2018

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 9/14/2018

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 10/14/2018

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 12/24/2020

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

Changed on 12/30/2020

VAERS ID: 459641 Before After
VAERS Form:1
Age:19.0
Sex:Male
Location:Ohio
Vaccinated:2012-01-19
Onset:2012-01-28
Submitted:2012-07-13
Entered:2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC010AB / 3 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB532AA / 1 RA / UN
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR 11451 / 1 LA / UN
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U3399CA / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0342AA / 1 RA / UN

Administered by: Public      Purchased by: Public
Symptoms: Death, Excessive exercise, Unresponsive to stimuli, Congestive cardiomyopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-01-28
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: None
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data: Death certificate - cause of death - dilated cardiomyopathy, excessive exercise on treadmill
CDC 'Split Type':

Write-up: No previous problems known. Pt was found unresponsive in rec room of home with treadmill running.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=459641&WAYBACKHISTORY=ON


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