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This is VAERS ID 151618

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151618
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 91682 / 0 LL / IM
HBHEPB: COMVAX / MSD 0964J / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD R02362 / 0 RL / -

Administered by: Public      Purchased by: Unknown
Symptoms: RHINITIS, EDEMA LUNG, DIARRHEA, HEM LUNG, PNEUMONIA INTERSTIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant exp"erienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 12/8/2009

VAERS ID: 151618 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 91682 / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0964J / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R02362 / 0 RL / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema, RHINITIS, EDEMA LUNG, DIARRHEA, HEM LUNG, PNEUMONIA INTERSTIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant exp"erienced experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 8/31/2010

VAERS ID: 151618 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 0 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 4/13/2011

VAERS ID: 151618 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 0 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 5/13/2011

VAERS ID: 151618 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 0 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 6/11/2011

VAERS ID: 151618 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 0 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 9/14/2017

VAERS ID: 151618 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 0 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 2/14/2018

VAERS ID: 151618 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 6/14/2018

VAERS ID: 151618 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 8/14/2018

VAERS ID: 151618 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 9/14/2018

VAERS ID: 151618 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.


Changed on 10/14/2018

VAERS ID: 151618 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Pennsylvania
Vaccinated:2000-05-02
Onset:2000-05-04
Submitted:2000-05-04
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 91682 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0964J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R02362 / 1 RL / -

Administered by: Public      Purchased by: Public
Symptoms: Coma, Diarrhoea, Nasal congestion, Pneumonitis, Pulmonary haemorrhage, Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-04
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: Augmentin
Current Illness: nasal congestion
Preexisting Conditions: hx of otitis media, bronchiolitis, colic, gas, seborrhea
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Mother stated to MD that the baby was fed formula and at 3:00am was returned to his crib. Baby seems to be sleeping later than usual and when mother checked infant at approximately 8:00am he was on his back and unresponsive. Per mothers report, infant experienced diarrhea, nasal congestion, no fever was noted. Autopsy states cause of death as interstital pneumonitis. Autopsy shows also pulmonary edema, focal intrapulmonic hemorrhage.

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