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This is VAERS ID 152301

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152301
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467673 / 0 - / IM
HBHEPB: COMVAX / MSD 1409J / 0 - / IM
IPV: IPV / MERIEUX INST R06172 / - - / -

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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this.


Changed on 12/8/2009

VAERS ID: 152301 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-25 2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 467673 / 0 - / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1409J / 0 - / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R06172 / - - / -

Administered by: Private      Purchased by: Unknown Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 5/14/2017

VAERS ID: 152301 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 467673 / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 0 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / - - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 9/14/2017

VAERS ID: 152301 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 0 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / - UNK - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 2/14/2018

VAERS ID: 152301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / UNK - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 6/14/2018

VAERS ID: 152301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / UNK - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 8/14/2018

VAERS ID: 152301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / UNK - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 9/14/2018

VAERS ID: 152301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / UNK - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."


Changed on 10/14/2018

VAERS ID: 152301 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-04-17
Onset:2000-04-18
Submitted:2000-04-30
Entered:2000-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467673 / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1409J / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / UNK - / -

Administered by: Private      Purchased by: Private
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Presumed SIDS approximately 20 hours after vaccine administration. An unofficial coroners report confirmed this. Follow up 09/11/2000: "Anthrax adsorbed/Michigan DPH Lot # 1 FAV 030."

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=152301&WAYBACKHISTORY=ON


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