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This is VAERS ID 151190

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151190
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTAP9121A2 / 1 RL / IM
HBHEPB: COMVAX / MSD 1980J / 1 LL / IM
IPV: IPV / MERIEUX INST R0444 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type':

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was"not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed


Changed on 12/8/2009

VAERS ID: 151190 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-04 2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM DTAP9121A2 9121A2 / 1 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1980J / 1 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R0444 / 1 LL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': (blank) OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was"not was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


Changed on 9/14/2017

VAERS ID: 151190 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 1 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 1 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


Changed on 2/14/2018

VAERS ID: 151190 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


Changed on 6/14/2018

VAERS ID: 151190 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


Changed on 8/14/2018

VAERS ID: 151190 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


Changed on 9/14/2018

VAERS ID: 151190 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.


Changed on 10/14/2018

VAERS ID: 151190 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Oregon
Vaccinated:2000-04-06
Onset:2000-04-09
Submitted:2000-04-18
Entered:2000-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9121A2 / 2 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1980J / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0444 / 2 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-09
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:
CDC 'Split Type': OR200012

Write-up: The reporter received a telephone call from a medical examiner who indicated that on 4/9/00, the pt died of a presumed SIDS. History that the medical examiner obtained from the mother indicated that she and the baby had gone to bed about 3:00am which was not unusual for the baby. The mother slept in the bed with the baby until about 2:00pm when mom awoke. She found the baby dead. The baby was sleeping on his tummy, which has been her practice, as she indicated to the medical examiner that the baby seemed to sleep better and longer and fussed less when he slept on his tummy. In addition, the medical examiner notes that this was a soft bed with a depression in the middle with quite a bit of bed clothes etc, including an electric blanket. He indicates that the entire family were heavy smokers. Medical examiner did not see any evidence of foul play. He is signing this out as a SIDS.

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