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This is VAERS ID 152001

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152001
VAERS Form:
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTPA919A2 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE ENG2962A2 / 0 RL / -
HIBV: PEDVAXHIB / MSD 0874J / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD PO257 / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 12/8/2009

VAERS ID: 152001 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-18 2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM DTPA919A2 919A2 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG2962A2 2962A2 / 0 RL / -
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0874J / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. PO257 / 0 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 9/14/2017

VAERS ID: 152001 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 0 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 0 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 2/14/2018

VAERS ID: 152001 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 6/14/2018

VAERS ID: 152001 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 8/14/2018

VAERS ID: 152001 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 9/14/2018

VAERS ID: 152001 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).


Changed on 10/14/2018

VAERS ID: 152001 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maine
Vaccinated:2000-04-13
Onset:2000-04-18
Submitted:2000-05-10
Entered:2000-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2962A2 / 1 RL / -
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0874J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. PO257 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-18
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: Postmortem exam.
CDC 'Split Type':

Write-up: Two month old died of SIDS 5 days post vax (1st set).

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=152001&WAYBACKHISTORY=ON


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