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This is VAERS ID 512796

History of Changes from the VAERS Wayback Machine

First Appeared on 11/13/2013

VAERS ID: 512796
VAERS Form:
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / - UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.


Changed on 9/14/2017

VAERS ID: 512796 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / - UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / - UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.


Changed on 2/14/2018

VAERS ID: 512796 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.


Changed on 6/14/2018

VAERS ID: 512796 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.


Changed on 8/14/2018

VAERS ID: 512796 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.


Changed on 9/14/2018

VAERS ID: 512796 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.


Changed on 10/14/2018

VAERS ID: 512796 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Foreign
Vaccinated:2013-08-19
Onset:2013-08-19
Submitted:2013-11-11
Entered:2013-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR - / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Death, Hypoxia, Irritability, Nuclear magnetic resonance imaging, Syncope, Polymerase chain reaction, Laboratory test, Toxicologic test, Culture negative, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Preexisting Conditions: Vitiligo; Constipation
Allergies:
Diagnostic Lab Data: Culture (date unknown): Negative
CDC 'Split Type': 2013315917

Write-up: This is a spontaneous report from a physician via the contactable regulatory authority received under the reference number GB-MHRA-ADR 22297675. A 5 month old female patient of an unspecified ethnicity started to receive PREVENAR 13 intramuscularly on 19Aug2013 at single dose, Men C vaccine (trade name unspecified) intramuscularly on 19Aug2013 at single dose and PEDIACEL intramuscularly on 19Aug2013 at single dose. Medical history included vitiligo and constipation. No congenital abnormalities were found. Healthy term baby with no past medical history of note. No relevant family history. Concomitant medication included macrogol, potassium chloride, sodium bicarbonate, MOVICOL. The patient had immunisations at 2:30pm. The patient was irritable at 7:30pm. at 8:30pm the patient was apnoeic leading to cardiac arrest that recovered at 9:10pm. The patient died due to severe hypoxic injury. No clear cause for collapse was ever found. There was no evidence of sepsis. Negative cultures and polymerase chain reaction reported. In the reporters opinion the events were considered serious due to being medically significant and fatal. Medically significant details: Collapse later that evening and cardiac arrest - cause of cardiac arrest is still unknown despite magnetic resonance imaging/toxicology/septic screen/metabolic screen. The patient did not receive a post mortem examination. Unclear whether the vaccinations played any part whatsoever in the collapse. In the opinion of the regulatory authority the events were considered serious for an unspecified reason. No follow-up attempts possible. No further information expected.

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