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This is VAERS ID 152501

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152501
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 916A2 / 0 - / IM
HIBV: ACT-HIB / CONNAUGHT LABS P0896AA / 0 - / IM
IPV: IPV / MERIEUX INST P0824 / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: SIDS


Changed on 12/8/2009

VAERS ID: 152501 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-31 2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 916A2 / 0 - / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES P0896AA / 0 - / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P0824 / 0 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) NH0011

Write-up: SIDS .


Changed on 5/14/2017

VAERS ID: 152501 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 0 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 0 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 0 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS .


Changed on 9/14/2017

VAERS ID: 152501 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 0 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 0 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS


Changed on 2/14/2018

VAERS ID: 152501 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS


Changed on 6/14/2018

VAERS ID: 152501 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS


Changed on 8/14/2018

VAERS ID: 152501 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS


Changed on 9/14/2018

VAERS ID: 152501 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS


Changed on 10/14/2018

VAERS ID: 152501 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:2000-01-14
Onset:2000-01-19
Submitted:2000-05-11
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P0896AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0824 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-01-19
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: ceftriaxone
Current Illness: Otitis Media
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0011

Write-up: SIDS

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=152501&WAYBACKHISTORY=ON


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