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This is VAERS ID 133897

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133897
VAERS Form:
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 464305 / 2 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: HYPOTONIA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA.


Changed on 12/8/2009

VAERS ID: 133897 Before After
VAERS Form:
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 464305 / 2 LL / IM

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Cardiac arrest, Hypotonia, HYPOTONIA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 5/14/2017

VAERS ID: 133897 Before After
VAERS Form:
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 464305 / 2 LL / IM

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 9/14/2017

VAERS ID: 133897 Before After
VAERS Form:(blank) 1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 2 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 11/14/2017

VAERS ID: 133897 Before After
VAERS Form:1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-02-14 2000-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 2/14/2018

VAERS ID: 133897 Before After
VAERS Form:1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 6/14/2018

VAERS ID: 133897 Before After
VAERS Form:1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 8/14/2018

VAERS ID: 133897 Before After
VAERS Form:1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 9/14/2018

VAERS ID: 133897 Before After
VAERS Form:1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.


Changed on 10/14/2018

VAERS ID: 133897 Before After
VAERS Form:1
Age:0.9
Sex:Male
Location:Florida
Vaccinated:2000-02-10
Onset:2000-02-10
Submitted:2000-02-11
Entered:2000-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 464305 / 3 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Hypotonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-10
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: Phenobarb
Current Illness: mild URI
Preexisting Conditions: possible seizure disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found to be cold & limp by mother who checked on him during his nap. Arrived in ER in asystole, DOA. 07/06/2000 Call from reporter today to say she finally obtained autopsy report and will fax it to us. 07/07/2000 autopsy report received from coroner. COD acute pulmonary decompensation due to DAD. Case complete.

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