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This is VAERS ID 154522

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 154522
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 920A2 / 2 RL / IM
HIBV: ACT-HIB / CONNAUGHT LABS 483AA / 2 LL / IM
PNC: PREVNAR / LEDERLE 471215 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: BIRTH PREMAT, ANOMALY CONGEN RESP

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 12/8/2009

VAERS ID: 154522 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-17 2000-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 920A2 / 2 RL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 483AA / 2 LL / IM
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE WYETH PHARMACEUTICALS, INC 471215 / 0 LL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Unevaluable event, BIRTH PREMAT, ANOMALY CONGEN RESP

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 3/2/2010

VAERS ID: 154522 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC 471215 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 4/7/2010

VAERS ID: 154522 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 2 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC 471215 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 8/31/2010

VAERS ID: 154522 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH 471215 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 6/11/2011

VAERS ID: 154522 Before After
VAERS Form:
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-19 2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 2 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 9/14/2017

VAERS ID: 154522 Before After
VAERS Form:(blank) 1
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 2 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 2 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 0 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 2/14/2018

VAERS ID: 154522 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 6/14/2018

VAERS ID: 154522 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 8/14/2018

VAERS ID: 154522 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 9/14/2018

VAERS ID: 154522 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.


Changed on 10/14/2018

VAERS ID: 154522 Before After
VAERS Form:1
Age:
Sex:Male
Location:Florida
Vaccinated:2000-05-10
Onset:2000-05-13
Submitted:2000-06-08
Entered:2000-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 920A2 / 3 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 483AA / 3 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471215 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-05-13
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:
Preexisting Conditions: premature, BPD, failure to thrive
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Three days post vax the pt died of unknown cause most likely related to severe BPD, prematurity and failure to thrive.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=154522&WAYBACKHISTORY=ON


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