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This is VAERS ID 151620

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151620
VAERS Form:
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE A919A2 / 0 LL / IM
HBHEPB: COMVAX / MSD 0963J / 0 RL / IM
IPV: IPV / MERIEUX INST R03972 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 12/8/2009

VAERS ID: 151620 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM A919A2 / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0963J / 0 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R03972 / 0 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 9/14/2017

VAERS ID: 151620 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 2/14/2018

VAERS ID: 151620 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 6/14/2018

VAERS ID: 151620 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 8/14/2018

VAERS ID: 151620 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 9/14/2018

VAERS ID: 151620 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.


Changed on 10/14/2018

VAERS ID: 151620 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Louisiana
Vaccinated:2000-04-17
Onset:2000-04-17
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A919A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0963J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R03972 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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: carbinoxamine oral drops, Mylicon
Current Illness: cold
Preexisting Conditions: Prematurity at 26 weeks, agenesis of corpus collisus
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt went to local ER dead on arrival. Follow-up with mom states she brought baby to ER because he stopped breathing. Autopsy revealed SIDS.

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