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This is VAERS ID 156861

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 156861
VAERS Form:
Age:0.3
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: CERTIVA / NORTH AMERICAN V D009 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 0147K / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 581313A / 0 RL / IM
IPV: IPV / MERIEUX INST P0739 / 0 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type':

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that"she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. Sh


Changed on 12/8/2009

VAERS ID: 156861 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-18 2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: CERTIVA DTAP (CERTIVA) / NORTH AMERICAN V NORTH AMERICAN VACCINES D009 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0147K / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 581313A / 0 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P0739 / 0 LL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': (blank) AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that"she that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. Sh She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 2/14/2017

VAERS ID: 156861 Before After
VAERS Form:
Age:0.3 0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 581313A / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 0 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 9/14/2017

VAERS ID: 156861 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 0 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 2/14/2018

VAERS ID: 156861 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 6/14/2018

VAERS ID: 156861 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 8/14/2018

VAERS ID: 156861 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 9/14/2018

VAERS ID: 156861 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.


Changed on 10/14/2018

VAERS ID: 156861 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Alabama
Vaccinated:2000-06-06
Onset:2000-06-09
Submitted:2000-06-29
Entered:2000-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (CERTIVA) / NORTH AMERICAN VACCINES D009 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0147K / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581313A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P0739 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-09
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: Mylicon drops
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Autopsy done-SIDS
CDC 'Split Type': AL0009

Write-up: Infant was given routine 2 month IZ on 6/6/00 and on 6/9/00, the infant was found in his crib at 06:15 AM and was not breathing. Maternal grandmother found infant. She states infant was fine after receiving IZ but was fussy but no fever. She reported that she gave the infant o.4 ml of infant acetaminophen to ease soreness in infants legs. She denies any problems, no fever, etc. On 6/7/00 and 6/8/00, child took formula well. On 6/8/00, she fed baby a bottle of formula with cereal and rocked him to sleep. She placed infant in his crib on his stomach. Mother of baby checked on him at midnight and placed baby on his side. At 06:15 AM, grandmother got up, put a bottle of formula in hot water for feeding infant and then went in to check on infant. She states that she thought he was asleep but then noticed infant was not breathing (when she went in the room baby was found on his stomach, face down, in middle of baby crib; covers at waist.) She states she called out to the infant''s mother and to grandfather of baby that infant was not breathing and to call 911. Paramedics arrived and attempted to revive infant, then transported infant to hospital, where staff attempted life saving efforts but were unsuccessful. Autopsy has been performed and per death certificate, cause of death was Sudden Infant Death Syndrome, undetermined circumstances. Health Dept not aware of child''s death until 6/29/2000.

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