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This is VAERS ID 152417

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152417
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7389AA / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 530453A / 0 RL / IM
IPV: IPV / MERIEUX INST P13812 / 0 - / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, EDEMA LUNG, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


Changed on 12/8/2009

VAERS ID: 152417 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-30 2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7389AA / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 530453A / 0 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P13812 / 0 - / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Pulmonary congestion, Pulmonary oedema, SIDS, Sudden infant death syndrome, EDEMA LUNG, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema .


Changed on 5/14/2017

VAERS ID: 152417 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 530453A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 0 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema .


Changed on 9/14/2017

VAERS ID: 152417 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 0 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


Changed on 2/14/2018

VAERS ID: 152417 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


Changed on 6/14/2018

VAERS ID: 152417 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


Changed on 8/14/2018

VAERS ID: 152417 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


Changed on 9/14/2018

VAERS ID: 152417 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema


Changed on 10/14/2018

VAERS ID: 152417 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Ohio
Vaccinated:2000-05-22
Onset:2000-05-25
Submitted:2000-05-25
Entered:2000-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7389AA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 530453A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P13812 / 1 - / SC

Administered by: Private      Purchased by: Public
Symptoms: Pulmonary congestion, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-25
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: Autopsy pending
CDC 'Split Type':

Write-up: SIDS. Autopsy shows pulmonary congestion and edema

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