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This is VAERS ID 151621

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151621
VAERS Form:
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0045BA / 0 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 56092A / 0 RL / IM
IPV: IPV / MERIEUX INST R0100 / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome.


Changed on 12/8/2009

VAERS ID: 151621 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05 2000-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0045BA / 0 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES 56092A / 0 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R0100 / 0 LL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, Cardiac arrest, SIDS, Sudden infant death syndrome, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 6/11/2011

VAERS ID: 151621 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-09 2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 56092A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 2/14/2017

VAERS ID: 151621 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 0 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 56092A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 9/14/2017

VAERS ID: 151621 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 0 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 0 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 2/14/2018

VAERS ID: 151621 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 6/14/2018

VAERS ID: 151621 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 8/14/2018

VAERS ID: 151621 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 9/14/2018

VAERS ID: 151621 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".


Changed on 10/14/2018

VAERS ID: 151621 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Connecticut
Vaccinated:2000-05-02
Onset:2000-05-03
Submitted:2000-05-03
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0045BA / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 56092A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0100 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-03
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: Previous rule/out Sepsis with/out dx viral
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found apneic and asystolic, tied up in blankets 24 hours after vax. Autopsy shows final cause of death as sudden infant death syndrome. A follow up report received 6/12/2000 clarifies that pt was found "tangled up in his blankets" rather than "tied up in blankets".

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=151621&WAYBACKHISTORY=ON


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