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This is VAERS ID 159916

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 159916
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0317BB / 0 RL / IM
HBHEPB: COMVAX / MSD 0555K / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD T0120 / 0 RL / SC
PNC: PREVNAR / LEDERLE 471655 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: CYANOSIS, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


Changed on 12/8/2009

VAERS ID: 159916 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0317BB / 0 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0555K / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. T0120 / 0 RL / SC
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 471655 / 0 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest, CYANOSIS, APNEA, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole. .


Changed on 3/2/2010

VAERS ID: 159916 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 471655 / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole. .


Changed on 4/7/2010

VAERS ID: 159916 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 471655 / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole. .


Changed on 5/14/2017

VAERS ID: 159916 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 471655 / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole. .


Changed on 9/14/2017

VAERS ID: 159916 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


Changed on 2/14/2018

VAERS ID: 159916 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


Changed on 6/14/2018

VAERS ID: 159916 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


Changed on 8/14/2018

VAERS ID: 159916 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


Changed on 9/14/2018

VAERS ID: 159916 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.


Changed on 10/14/2018

VAERS ID: 159916 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Texas
Vaccinated:2000-09-11
Onset:2000-09-14
Submitted:2000-09-14
Entered:2000-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0555K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0120 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471655 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac arrest, Cyanosis, Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-14
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 9/14/00, the baby was found blue and not breathing at 12:30 PM. Baby had been put to sleep at 10:30 am. Paramedics were unable to intubate due to rigor mortis. Taken to the ER and pronounced dead on arrival as pt was in asystole.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=159916&WAYBACKHISTORY=ON


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