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This is VAERS ID 152502

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 152502
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS UA475AA / 0 - / IM
IPV: IPV / MERIEUX INST P0823 / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: HEMOPTYSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 12/8/2009

VAERS ID: 152502 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-31 2000-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA475AA / 0 - / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P0823 / 0 - / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Haemoptysis, HEMOPTYSIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 6/11/2011

VAERS ID: 152502 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-06-07 2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UA475AA / 0 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 0 - / -

Administered by: Private      Purchased by: Other
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 10/14/2016

VAERS ID: 152502 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) DTAP (INFANRIX) / CONNAUGHT LABORATORIES SMITHKLINE BEECHAM UA475AA 916A2 / 0 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 0 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 0 - / -

Administered by: Private      Purchased by: Other Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 2/14/2017

VAERS ID: 152502 Before After
VAERS Form:
Age:0.1 0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 0 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 0 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 0 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 9/14/2017

VAERS ID: 152502 Before After
VAERS Form:(blank) 1
Age:0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 0 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 0 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 2/14/2018

VAERS ID: 152502 Before After
VAERS Form:1
Age:0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 6/14/2018

VAERS ID: 152502 Before After
VAERS Form:1
Age:0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 8/14/2018

VAERS ID: 152502 Before After
VAERS Form:1
Age:0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 9/14/2018

VAERS ID: 152502 Before After
VAERS Form:1
Age:0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.


Changed on 10/14/2018

VAERS ID: 152502 Before After
VAERS Form:1
Age:0.08
Sex:Male
Location:Alabama
Vaccinated:1999-12-06
Onset:1999-12-07
Submitted:1999-12-10
Entered:2000-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 916A2 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER UA475AA / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0823 / 1 - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Haemoptysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-12-07
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: Cleft palate, Hypospadias
Allergies:
Diagnostic Lab Data: Autopsy pending.
CDC 'Split Type':

Write-up: Post vax, infant was in bed with parents - found with mucus and blood in mouth early in the morning on 12/07. 911 was called. Unable to resuscitate. Both parents smoke. Moved into new trailer recently.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=152502&WAYBACKHISTORY=ON


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