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This is VAERS ID 150974

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 150974
VAERS Form:
Age:0.3
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 920AZ / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 591313A / 0 LL / IM
IPV: IPV / MERIEUX INST P12313 / 0 LL / SC
UNK: UNK. UNCLASSIFIED VACCINE / UNCLASSIFIED 909906 / 1 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, ENCEPHALOPATHY, HEM LUNG, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 12/8/2009

VAERS ID: 150974 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 920AZ / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES 591313A / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P12313 / 0 LL / SC
UNK: UNK. UNCLASSIFIED VACCINE / UNCLASSIFIED 909906 / 1 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, SIDS, Sudden infant death syndrome, ENCEPHALOPATHY, HEM LUNG, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 2/14/2017

VAERS ID: 150974 Before After
VAERS Form:
Age:0.3 0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 591313A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 5/14/2017

VAERS ID: 150974 Before After
VAERS Form:
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 591313A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 9/14/2017

VAERS ID: 150974 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 0 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 2/14/2018

VAERS ID: 150974 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 6/14/2018

VAERS ID: 150974 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 8/14/2018

VAERS ID: 150974 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 9/14/2018

VAERS ID: 150974 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages


Changed on 10/14/2018

VAERS ID: 150974 Before After
VAERS Form:1
Age:0.25
Sex:Female
Location:Washington
Vaccinated:2000-03-29
Onset:2000-04-02
Submitted:2000-04-05
Entered:2000-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920AZ / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P12313 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Encephalopathy, Hypoxia, Pulmonary haemorrhage, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-02
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: Synagis Lot number 909906
Current Illness: URI
Preexisting Conditions: 31 week preemie
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected SIDS. Autopsy also shows hypoxic encephalopathy, subpleural pulmonary hemorrhages

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=150974&WAYBACKHISTORY=ON


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