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This is VAERS ID 158090

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 158090
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7BF1603 / 1 LL / IM
HEP: RECOMBIVAX HB / MSD 0312E / 1 RL / IM
HIBV: ACT-HIB / CONNAUGHT LABS 9D91711 / 1 RL / IM
IPV: IPV / MERIEUX INST M1294 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


Changed on 12/8/2009

VAERS ID: 158090 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7BF1603 / 1 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0312E / 1 RL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 9D91711 / 1 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. M1294 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS. .


Changed on 5/14/2017

VAERS ID: 158090 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS. .


Changed on 9/14/2017

VAERS ID: 158090 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 1 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 1 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 1 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


Changed on 2/14/2018

VAERS ID: 158090 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


Changed on 6/14/2018

VAERS ID: 158090 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


Changed on 8/14/2018

VAERS ID: 158090 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


Changed on 9/14/2018

VAERS ID: 158090 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.


Changed on 10/14/2018

VAERS ID: 158090 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Connecticut
Vaccinated:1997-09-15
Onset:0000-00-00
Submitted:2000-07-25
Entered:2000-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7BF1603 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0312E / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 9D91711 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1294 / 2 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-10-10
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: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy case #97-10761
CDC 'Split Type':

Write-up: Pt was found in his crib at daycare on 10/10/1997, having died from SIDS. Doctor spoke with other doctor on 10/15/1997, who said that the autopsy confirmed SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=158090&WAYBACKHISTORY=ON


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