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This is VAERS ID 153392

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 153392
VAERS Form:
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 469396 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE ENG3137A2 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 601063A / 0 LL / IM
IPV: IPV / MERIEUX INST R0235 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


Changed on 12/8/2009

VAERS ID: 153392 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 469396 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG3137A2 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 601063A / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R0235 / 0 LL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Asphyxia, Unevaluable event, REACT UNEVAL, ASPHYXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia .


Changed on 5/14/2017

VAERS ID: 153392 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 469396 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 601063A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 0 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia .


Changed on 9/14/2017

VAERS ID: 153392 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 0 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


Changed on 2/14/2018

VAERS ID: 153392 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


Changed on 6/14/2018

VAERS ID: 153392 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


Changed on 8/14/2018

VAERS ID: 153392 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


Changed on 9/14/2018

VAERS ID: 153392 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


Changed on 10/14/2018

VAERS ID: 153392 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nevada
Vaccinated:2000-06-01
Onset:2000-06-02
Submitted:2000-06-08
Entered:2000-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Asphyxia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-02
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: PKU-nml
CDC 'Split Type':

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia

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