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This is VAERS ID 155423

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 155423
VAERS Form:
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 918A2 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 1671J / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 591313A / 0 LL / IM
IPV: IPV / MERIEUX INST P0998 / 0 RL / IM

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, STUPOR, EDEMA LUNG, PNEUMONIA, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 12/8/2009

VAERS ID: 155423 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-28 2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 918A2 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1671J / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES 591313A / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P0998 / 0 RL / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Coma, Pneumonitis, Pulmonary congestion, Pulmonary oedema, SIDS, Sudden infant death syndrome, STUPOR, EDEMA LUNG, PNEUMONIA, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 2/14/2017

VAERS ID: 155423 Before After
VAERS Form:
Age:0.3 0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 591313A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 5/14/2017

VAERS ID: 155423 Before After
VAERS Form:
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 591313A / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 9/14/2017

VAERS ID: 155423 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 0 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 2/14/2018

VAERS ID: 155423 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 6/14/2018

VAERS ID: 155423 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 8/14/2018

VAERS ID: 155423 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 9/14/2018

VAERS ID: 155423 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema


Changed on 10/14/2018

VAERS ID: 155423 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Michigan
Vaccinated:2000-06-16
Onset:0000-00-00
Submitted:2000-06-20
Entered:2000-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1671J / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 591313A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0998 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-18
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: Autopsy pending
CDC 'Split Type':

Write-up: Baby died from SIDS, according to pathologist. Autopsy also showed diffuse patchy lymphocytic pneumonitis, found unresponsive, lung congestion, pulmonary edema

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