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This is VAERS ID 156370

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 156370
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS UD173CA / 0 LL / -
HEP: RECOMBIVAX HB / MSD 0151K / 1 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: DIC, ACIDOSIS, ANEMIA, ENCEPHALOPATHY, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arres"t. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus


Changed on 12/30/2006

VAERS ID: 156370 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS UD173CA / 0 LL / -
HEP: RECOMBIVAX HB / MSD 0151K / 1 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: DIC, ACIDOSIS, ANEMIA, ENCEPHALOPATHY, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arres"t. On history, pt had received Hep-B #2, and DTAP at PMD''s PMD''''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus staphylococcu


Changed on 12/8/2009

VAERS ID: 156370 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES UD173CA / 0 LL / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0151K / 1 RL / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, DIC, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection, ACIDOSIS, ANEMIA, ENCEPHALOPATHY, CARDIOVASC DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arres"t. arrest. On history, pt had received Hep-B #2, and DTAP at PMD''''s PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcu staphylococcus aureus bronchopneumonia is contributory factor.


Changed on 9/14/2017

VAERS ID: 156370 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 0 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 1 2 RL / -

Administered by: Private      Purchased by: Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.


Changed on 2/14/2018

VAERS ID: 156370 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 2 RL / -

Administered by: Private      Purchased by: Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.


Changed on 6/14/2018

VAERS ID: 156370 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 2 RL / -

Administered by: Private      Purchased by: Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.


Changed on 8/14/2018

VAERS ID: 156370 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 2 RL / -

Administered by: Private      Purchased by: Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.


Changed on 9/14/2018

VAERS ID: 156370 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 2 RL / -

Administered by: Private      Purchased by: Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.


Changed on 10/14/2018

VAERS ID: 156370 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Texas
Vaccinated:2000-07-06
Onset:2000-07-07
Submitted:2000-07-11
Entered:2000-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES UD173CA / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0151K / 2 RL / -

Administered by: Private      Purchased by: Other
Symptoms: Acidosis, Anaemia, Blood potassium increased, Cardio-respiratory arrest, Disseminated intravascular coagulation, Encephalopathy, Hypoxia, Pneumonia, Pulse absent, Viral infection, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-07
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: NONE
Allergies:
Diagnostic Lab Data: Pt in ICU-PH $g212, WBC-nml, initial Hemoglobin-nml, then <5. Initially severe acidosis, never corrected: potassium increased to 8.6
CDC 'Split Type':

Write-up: Pt found asystolic and pulseless in the field. Received epinephrine X 4 with heart rate obtained. Transferred to ICU, intubated but no respirations, fixed pupils, no corneals. Initial PH=6.5, pt died about 15 hours after arrival with cardiopulmonary arrest. On history, pt had received Hep-B #2, and DTAP at PMD''s office on the day prior to death (<24 hours). Cause of death Hypoxic ischemic encephalopathy with disseminated intravascular coagulopathy, probably due to viral infection. Secondary staphylococcus aureus bronchopneumonia is contributory factor.

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