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This is VAERS ID 159003

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 159003
VAERS Form:
Age:0.2
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467674 / - - / IM
HBHEPB: COMVAX / MSD 0293K / - - / IM
IPV: IPV / MERIEUX INST R12512 / - - / -
PNC: PREVNAR / LEDERLE 469692 / - - / IM

Administered by: ??      Purchased by: Unknown
Symptoms: SIDS, CYANOSIS, STUPOR, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


Changed on 12/8/2009

VAERS ID: 159003 Before After
VAERS Form:
Age:0.2 0.3
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-22 2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 467674 / - - / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0293K / - - / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R12512 / - - / -
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 469692 / - - / IM

Administered by: ??      Purchased by: Unknown (blank)
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, SIDS, Sudden infant death syndrome, CYANOSIS, STUPOR, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome. .


Changed on 3/2/2010

VAERS ID: 159003 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 467674 / - - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / - - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / - - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 469692 / - - / IM

Administered by: ??      Purchased by: ??
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome. .


Changed on 4/7/2010

VAERS ID: 159003 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 467674 / - - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / - - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / - - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 469692 / - - / IM

Administered by: ??      Purchased by: ??
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome. .


Changed on 2/14/2017

VAERS ID: 159003 Before After
VAERS Form:
Age:0.3 0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 467674 / - - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / - - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / - - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 469692 / - - / IM

Administered by: (blank) Unknown      Purchased by: (blank) Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome. .


Changed on 9/14/2017

VAERS ID: 159003 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / - UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / - UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / - UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


Changed on 2/14/2018

VAERS ID: 159003 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


Changed on 6/14/2018

VAERS ID: 159003 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


Changed on 8/14/2018

VAERS ID: 159003 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


Changed on 9/14/2018

VAERS ID: 159003 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.


Changed on 10/14/2018

VAERS ID: 159003 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Unknown
Vaccinated:2000-08-04
Onset:2000-08-05
Submitted:2000-08-08
Entered:2000-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467674 / UNK - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0293K / UNK - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R12512 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 469692 / UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Apnoea, Cardiac arrest, Coma, Cyanosis, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-08-05
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: Tylenol infant
Current Illness:
Preexisting Conditions: mother has hx of smoking during pregnancy
Allergies:
Diagnostic Lab Data: preliminary autopsy report-SIDS
CDC 'Split Type':

Write-up: Next day post vax, the pt was found blue and unresponsive. Efforts to resuscitate were unsuccessful. Autopsy states cause of death as sudden infant death syndrome.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=159003&WAYBACKHISTORY=ON


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