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This is VAERS ID 521292

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2014

VAERS ID: 521292
VAERS Form:
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGICOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F47829 / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 2/14/2017

VAERS ID: 521292 Before After
VAERS Form:
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGICOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / - UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / - UN / UN
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH F47829 / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 9/14/2017

VAERS ID: 521292 Before After
VAERS Form:(blank) 1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGICOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / - UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / - UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / - UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 1/14/2018

VAERS ID: 521292 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGICOCCAL CONJUGATE + HIB (UNKNOWN) MENINGOCOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 2/14/2018

VAERS ID: 521292 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGOCOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 6/14/2018

VAERS ID: 521292 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGOCOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 8/14/2018

VAERS ID: 521292 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGOCOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 9/14/2018

VAERS ID: 521292 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGOCOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.


Changed on 10/14/2018

VAERS ID: 521292 Before After
VAERS Form:1
Age:1.2
Sex:Female
Location:Foreign
Vaccinated:2013-09-16
Onset:2013-09-23
Submitted:2014-01-29
Entered:2014-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENHIB: MENINGOCOCCAL CONJUGATE + HIB (UNKNOWN) / UNKNOWN MANUFACTURER A76CA230A / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H0069789 / UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2013-09-23
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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 2014022489

Write-up: This is a spontaneous report from a contactable consumer, the patient''s parent. This is a report received from a foreign Regulatory Agency. Regulatory authority report number ADR22389233. A 14-month-old female patient of an unspecified ethnicity received PREVENAR (Lot Number: F47829; Expiration Date: Apr2014), MMRVAXPRO (Lot Number: H0069789), MENTORIX (Lot Number: A76CA230A or A76CA176B; Expiration Date May 2015), PRIORIX (Lot Number A69DD408A: Expiration Date: Feb2015); all via the "parenteral" route of administration on 16Sep2013 at single doses. The patient''s medical history and concomitant medications were not reported. On 23Sep2013, the patient died. It was unknown if an autopsy was performed and the cause of death was reported as "death unexplained". The reporter stated that they were unsure which injections their child was given as their general practitioner (GP) provided all the above batch numbers. The reporter was given six completely different batch numbers for three injections and was unsure that their child was given the incorrect vaccine. The reporter further stated that the GP was reluctant to inform the local regulatory authority. No follow up attempts possible. No further information expected.

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