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This is VAERS ID 150475

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150475
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: UNK. DTAP / UNCLASSIFIED - / - - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


Changed on 12/8/2009

VAERS ID: 150475 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-29 2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: UNK. DTAP DTAP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Cardiac arrest, SIDS, Sudden infant death syndrome, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome .


Changed on 5/14/2017

VAERS ID: 150475 Before After
VAERS Form:
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome .


Changed on 9/14/2017

VAERS ID: 150475 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


Changed on 2/14/2018

VAERS ID: 150475 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


Changed on 6/14/2018

VAERS ID: 150475 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


Changed on 8/14/2018

VAERS ID: 150475 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


Changed on 9/14/2018

VAERS ID: 150475 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome


Changed on 10/14/2018

VAERS ID: 150475 Before After
VAERS Form:1
Age:0.5
Sex:Male
Location:Illinois
Vaccinated:2000-03-15
Onset:2000-03-17
Submitted:2000-03-29
Entered:2000-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-18
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: NONE
Allergies:
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: Pt received vaccination 2 days prior to arrival at ER in full cardiac arrest. Autopsy shows cause of death as sudden infant death syndrome

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