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This is VAERS ID 592715

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2015

VAERS ID: 592715
VAERS Form:
Age:1.8
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 2 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 2/14/2017

VAERS ID: 592715 Before After
VAERS Form:
Age:1.8 1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 0 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 0 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 0 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 2 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 9/14/2017

VAERS ID: 592715 Before After
VAERS Form:(blank) 1
Age:1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 0 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 0 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 0 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 2 3 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 2/14/2018

VAERS ID: 592715 Before After
VAERS Form:1
Age:1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 3 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 6/14/2018

VAERS ID: 592715 Before After
VAERS Form:1
Age:1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 3 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 8/14/2018

VAERS ID: 592715 Before After
VAERS Form:1
Age:1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 3 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 9/14/2018

VAERS ID: 592715 Before After
VAERS Form:1
Age:1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 3 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.


Changed on 10/14/2018

VAERS ID: 592715 Before After
VAERS Form:1
Age:1.75
Sex:Female
Location:Alabama
Vaccinated:2015-08-31
Onset:2015-09-01
Submitted:2015-09-03
Entered:2015-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C4679AA / 1 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9CJ5Y / 1 LL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. K022448 / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L60102 / 3 RL / UN

Administered by: Private      Purchased by: Public
Symptoms: Blood pH decreased, Cardiac arrest, Life support, pH urine normal, Retching, Drug screen negative, Urine ketone body present

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-09-01
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No illness
Preexisting Conditions: Umbilicus hernia since birth
Allergies:
Diagnostic Lab Data: Urine drug screen negative; Urinalysis-ph5, ketones 15, blood ph 6.7
CDC 'Split Type':

Write-up: Dr received phone call from ER at 9:46 am. Dr at ER states child presented to the ER via personal automobile. Mom states patient was gagging all night. Child was in cardiac arrest when she arrived in the ER at 8:16 am. Pediatric advanced life support protocol active for one hour using every cardiac drug per Dr.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=592715&WAYBACKHISTORY=ON


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