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This is VAERS ID 158751

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 158751
VAERS Form:
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PREVNAR / LEDERLE 475228 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal.


Changed on 12/8/2009

VAERS ID: 158751 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-15 2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 475228 / 1 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardio-respiratory arrest, Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest. .


Changed on 3/2/2010

VAERS ID: 158751 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 475228 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest. .


Changed on 4/7/2010

VAERS ID: 158751 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 475228 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest. .


Changed on 5/14/2017

VAERS ID: 158751 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 475228 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest. .


Changed on 9/14/2017

VAERS ID: 158751 Before After
VAERS Form:(blank) 1
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 1 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.


Changed on 2/14/2018

VAERS ID: 158751 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.


Changed on 6/14/2018

VAERS ID: 158751 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.


Changed on 8/14/2018

VAERS ID: 158751 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.


Changed on 9/14/2018

VAERS ID: 158751 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.


Changed on 10/14/2018

VAERS ID: 158751 Before After
VAERS Form:1
Age:0.8
Sex:Male
Location:Wisconsin
Vaccinated:2000-07-27
Onset:2000-07-28
Submitted:2000-07-31
Entered:2000-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475228 / 2 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardio-respiratory arrest, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-28
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: Sinusitis
Preexisting Conditions: Walker-Warburg syndrome
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death. Doubt any relationship other than temporal. Cause of death given as cardio-pulmonary arrest.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=158751&WAYBACKHISTORY=ON


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