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This is VAERS ID 155590

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 155590
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 914A2 / 1 RL / IM
HEP: ENGERIX-B / SMITHKLINE ENG3088A2 / 1 RL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA103AA / 1 LL / IM
IPV: IPV / MERIEUX INST P06572 / 1 RL / -

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


Changed on 12/8/2009

VAERS ID: 155590 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-29 2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 914A2 / 1 RL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM ENG3088A2 / 1 RL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA103AA / 1 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P06572 / 1 RL / -

Administered by: Public      Purchased by: Unknown Public
Symptoms: Pulmonary congestion, SIDS, Sudden infant death syndrome, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma 4


Changed on 5/14/2017

VAERS ID: 155590 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma 4


Changed on 9/14/2017

VAERS ID: 155590 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 1 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 1 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 1 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


Changed on 2/14/2018

VAERS ID: 155590 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


Changed on 6/14/2018

VAERS ID: 155590 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


Changed on 8/14/2018

VAERS ID: 155590 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


Changed on 9/14/2018

VAERS ID: 155590 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma


Changed on 10/14/2018

VAERS ID: 155590 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:New Hampshire
Vaccinated:2000-01-03
Onset:2000-02-15
Submitted:0000-00-00
Entered:2000-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 914A2 / 2 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3088A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA103AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P06572 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-02-15
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: RSV, IUGR, neuro developmental disorder
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': NH0012

Write-up: SIDS. Autopsy states congested pulmonary parenchyma

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