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This is VAERS ID 151867

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151867
VAERS Form:
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0137BA / 0 LL / IM
HBHEPB: COMVAX / MSD 0284K / 0 RL / IM
IPV: IPV / MERIEUX INST R0618 / 0 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS.


Changed on 12/8/2009

VAERS ID: 151867 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-13 2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0137BA / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0284K / 0 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R0618 / 0 RL / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, SIDS, Sudden infant death syndrome, STUPOR, APNEA, MALAISE, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


Changed on 9/14/2017

VAERS ID: 151867 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 0 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


Changed on 2/14/2018

VAERS ID: 151867 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


Changed on 6/14/2018

VAERS ID: 151867 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


Changed on 8/14/2018

VAERS ID: 151867 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


Changed on 9/14/2018

VAERS ID: 151867 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.


Changed on 10/14/2018

VAERS ID: 151867 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Georgia
Vaccinated:2000-05-10
Onset:2000-05-11
Submitted:2000-05-11
Entered:2000-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0137BA / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0284K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0618 / 1 RL / SC

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Cardiac arrest, Coma, Feeling abnormal, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-11
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Prematurity, Twin A
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found lifeless, unresponsive and transported to hospital; CPR unsuccessful. SIDS. A follow up report received 6/12/2000 adds: Spoke to reporter who gave info from pt''s chart. Pt was a 33 week preemie and had bradycardia at birth which resolved almost immediately. Remained in hospital 13 days with twin who was smaller and was born with a cardiac defect. The baby was put to sleep on his side and was found by parents on stomach - resuscitation unsuccessful. He had not exhibited any problems in the evening before he was put to bed. Twin had no adverse reaction after vaccines. Pt was developmentally as advanced as full term baby. ME gave preliminary cause of death as SIDS.

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