National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 150874

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150874
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: CERTIVA / NORTH AMERICAN V 1004R / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 512453A / 1 RL / IM
IPV: IPV / MERIEUX INST P0474 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, APNEA, EDEMA LUNG, BRONCHITIS, BRONCHIOLITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema", tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 12/30/2006

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: CERTIVA / NORTH AMERICAN V 1004R / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 512453A / 1 RL / IM
IPV: IPV / MERIEUX INST P0474 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: CHILLS, APNEA, EDEMA LUNG, BRONCHITIS, BRONCHIOLITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s examiner''''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema", tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 12/8/2009

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: CERTIVA DTAP (CERTIVA) / NORTH AMERICAN V NORTH AMERICAN VACCINES 1004R / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 512453A / 1 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P0474 / 1 LL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis, CHILLS, APNEA, EDEMA LUNG, BRONCHITIS, BRONCHIOLITIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''''s examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema", edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 8/31/2010

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 512453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 4/13/2011

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 512453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 5/13/2011

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 512453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 6/11/2011

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 512453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 5/14/2017

VAERS ID: 150874 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 512453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 1 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 9/14/2017

VAERS ID: 150874 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 1 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 2/14/2018

VAERS ID: 150874 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 6/14/2018

VAERS ID: 150874 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 8/14/2018

VAERS ID: 150874 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 9/14/2018

VAERS ID: 150874 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death


Changed on 10/14/2018

VAERS ID: 150874 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Texas
Vaccinated:2000-04-06
Onset:2000-04-06
Submitted:2000-04-07
Entered:2000-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES 1004R / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 512453A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0474 / 2 LL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Bronchiolitis, Cardiac arrest, Chills, Hypotonia, Nasal congestion, Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome, Tracheobronchitis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-07
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: Amoxil completed on 4/3/2000 and Panmist
Current Illness: Cold
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy at examiner''s office
CDC 'Split Type':

Write-up: Child presented to ER, lifeless and not breathing. Baby cool with rigor mortis. Mom had fed infant at 13:30 and he was fine. At 17:00, noted to be pale and lifeless. CPR began and brought to ER. Autopsy shows pulmonary vascular congestion, pulmonary edema, tracheobronchitis with bronchiolotis and peri-bronchiolar pulmonary inflammation, generalized visceral congestion, sudden infant death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=150874&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166