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This is VAERS ID 150074

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150074
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: ACT-HIB / CONNAUGHT LABS UA485AA / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, FEVER, DUCT ART PAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death"was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further in


Changed on 12/30/2006

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: ACT-HIB / CONNAUGHT LABS UA485AA / - - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, FEVER, DUCT ART PAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Reportedly sometime post vax, the pt expired. The pt''s pt''''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s pt''''s cause of death"was dea"th was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further in


Changed on 12/8/2009

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-16 2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA485AA / - - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Patent ductus arteriosus, Pyrexia, SIDS, Sudden infant death syndrome, FEVER, DUCT ART PAT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''''s pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''''s pt''s cause of dea"th death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 8/31/2010

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 4/13/2011

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 5/13/2011

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 6/11/2011

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 2/14/2017

VAERS ID: 150074 Before After
VAERS Form:
Age:0.3 0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 9/14/2017

VAERS ID: 150074 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 2/14/2018

VAERS ID: 150074 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 6/14/2018

VAERS ID: 150074 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 8/14/2018

VAERS ID: 150074 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 9/14/2018

VAERS ID: 150074 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.


Changed on 10/14/2018

VAERS ID: 150074 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Virginia
Vaccinated:2000-03-11
Onset:2000-03-12
Submitted:2000-03-13
Entered:2000-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA485AA / UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Patent ductus arteriosus, Pyrexia, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-12
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: mild bronchitis
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': U2000001310

Write-up: Reportedly sometime post vax, the pt expired. The pt''s mother reported that the pt developed a fever before passing away. No specifics provided. From follow-up correspondence, the autopsy results were provided. It was reported that the pt''s cause of death was sudden death in infancy with ductus arteriosus aneurysm present. Such dilatations of a non-closed ductus arteriosus are and uncommon development anomaly, which have been associated with some sudden deaths. The manner of death is natural. No further information is anticipated.

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