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This is VAERS ID 152213

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152213
VAERS Form:
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 462354 / 0 RL / IM
HEP: ENGERIX-B / SMITHKLINE ENG3078A2 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 560903A / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD P0168 / 0 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: AGITATION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type':

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 12/8/2009

VAERS ID: 152213 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 462354 / 0 RL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG3078A2 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 560903A / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. P0168 / 0 LL / SC

Administered by: Public      Purchased by: Unknown Other
Symptoms: Agitation, AGITATION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': (blank) AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 5/14/2017

VAERS ID: 152213 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 462354 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 560903A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 0 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 9/14/2017

VAERS ID: 152213 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 0 1 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 2/14/2018

VAERS ID: 152213 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 6/14/2018

VAERS ID: 152213 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 8/14/2018

VAERS ID: 152213 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 9/14/2018

VAERS ID: 152213 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.


Changed on 10/14/2018

VAERS ID: 152213 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Arkansas
Vaccinated:2000-03-30
Onset:2000-03-31
Submitted:2000-03-31
Entered:2000-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3078A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560903A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. P0168 / 1 LL / SC

Administered by: Public      Purchased by: Other
Symptoms: Agitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-03-31
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: Autopsy report pending
CDC 'Split Type': AR0011

Write-up: Mother reports infant fussy night of 03/30/00. Laid infant on stomach and patted his back. Infant and mother fell asleep. Mother woke up and infant not breathing. Mother called 911.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=152213&WAYBACKHISTORY=ON


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