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This is VAERS ID 603163

History of Changes from the VAERS Wayback Machine

First Appeared on 11/14/2015

VAERS ID: 603163
VAERS Form:
Age:1.0
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 3 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 2 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 0 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 3 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 2/14/2017

VAERS ID: 603163 Before After
VAERS Form:
Age:1.0 1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 3 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 0 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 2 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 0 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 3 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 9/14/2017

VAERS ID: 603163 Before After
VAERS Form:(blank) 1
Age:1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 3 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 0 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 2 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 0 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 3 4 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 2/14/2018

VAERS ID: 603163 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 4 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 6/14/2018

VAERS ID: 603163 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 4 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 8/14/2018

VAERS ID: 603163 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 4 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 9/14/2018

VAERS ID: 603163 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 4 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.


Changed on 10/14/2018

VAERS ID: 603163 Before After
VAERS Form:1
Age:1.03
Sex:Male
Location:Georgia
Vaccinated:2015-10-05
Onset:2015-10-05
Submitted:0000-00-00
Entered:2015-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. L001626 / 4 LL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AD9Y4 / 1 LL / UN
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. K025005 / 3 LL / UN
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L023111 / 1 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH L36483 / 4 RL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Interstitial lung disease, Pyrexia, Sudden death, Viral myocarditis, Laboratory test normal, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2015-10-08
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: Eczema; Allergic rhinitis
Preexisting Conditions: Eczema; Allergic rhinitis
Allergies:
Diagnostic Lab Data: Coroner''s report that toxicology and all other labs were negative. No bacterial infec and no allergic reaction.
CDC 'Split Type':

Write-up: Pt. received physical and shots on 10/5/15 and passed 10/8/15. Per family he had a fever x2d, no fever on 3rd day or 4th day and then died suddenly on 10/8/15. The coroner''s preliminary slides show viral myocarditis and interstitial pneumonia.

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