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This is VAERS ID 150474

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150474
VAERS Form:
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467675 / 1 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA492AA / 1 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD P03033 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 12/8/2009

VAERS ID: 150474 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-29 2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 467675 / 1 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA492AA / 1 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. P03033 / 1 LL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 5/14/2017

VAERS ID: 150474 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 467675 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 9/14/2017

VAERS ID: 150474 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 1 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 1 2 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 2/14/2018

VAERS ID: 150474 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 6/14/2018

VAERS ID: 150474 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 8/14/2018

VAERS ID: 150474 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 9/14/2018

VAERS ID: 150474 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.


Changed on 10/14/2018

VAERS ID: 150474 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Montana
Vaccinated:2000-03-16
Onset:2000-03-17
Submitted:2000-03-21
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467675 / 2 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA492AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P03033 / 2 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-17
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Autopsy performed - results pending
CDC 'Split Type':

Write-up: Accidental suffocation 24 hours post vax.

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