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This is VAERS ID 475176

History of Changes from the VAERS Wayback Machine

First Appeared on 12/11/2012

VAERS ID: 475176
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 5/13/2013

VAERS ID: 475176 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 1 RL / IM
ROTHB5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 - / PO
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 6/14/2014

VAERS ID: 475176 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 3/14/2015

VAERS ID: 475176 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 2/14/2017

VAERS ID: 475176 Before After
VAERS Form:
Age:0.3 0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 0 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 9/14/2017

VAERS ID: 475176 Before After
VAERS Form:(blank) 1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 0 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 1 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 1 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 1 2 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 2/14/2018

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 6/14/2018

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 8/14/2018

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 9/14/2018

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 10/14/2018

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 12/24/2020

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

Changed on 12/30/2020

VAERS ID: 475176 Before After
VAERS Form:1
Age:0.33
Sex:Male
Location:Washington
Vaccinated:2012-10-29
Onset:2012-11-01
Submitted:0000-00-00
Entered:2012-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B351BA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH624AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH F70997 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0059AE / 2 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2012-11-01
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: Died of SIDS 2 days after receiving vaccines.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=475176&WAYBACKHISTORY=ON


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