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This is VAERS ID 160417

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 160417
VAERS Form:
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467010 / 0 RL / IM
HEP: RECOMBIVAX HB / MSD 0554K / 1 LL / IM
HIBV: PEDVAXHIB / MSD 0554K / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD R1433 / 0 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, REACT UNEVAL, EDEMA LUNG, LUNG DIS, ADREN DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: The reported states ""Don''t know"", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 12/30/2006

VAERS ID: 160417 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467010 / 0 RL / IM
HEP: RECOMBIVAX HB / MSD 0554K / 1 LL / IM
HIBV: PEDVAXHIB / MSD 0554K / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD R1433 / 0 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, REACT UNEVAL, EDEMA LUNG, LUNG DIS, ADREN DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: The reported states ""Don''t know"", /"Don''''t know/", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome. syndrome".


Changed on 12/8/2009

VAERS ID: 160417 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-11 2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 467010 / 0 RL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0554K / 1 LL / IM
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0554K / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R1433 / 0 LL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, SIDS, Sudden infant death syndrome, Unevaluable event, REACT UNEVAL, EDEMA LUNG, LUNG DIS, ADREN DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) KY2000033

Write-up: The reported states /"Don''''t know/", "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome". syndrome.


Changed on 5/14/2017

VAERS ID: 160417 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 467010 / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 0 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 9/14/2017

VAERS ID: 160417 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 0 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 1 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 0 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 2/14/2018

VAERS ID: 160417 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 6/14/2018

VAERS ID: 160417 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 8/14/2018

VAERS ID: 160417 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 9/14/2018

VAERS ID: 160417 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.


Changed on 10/14/2018

VAERS ID: 160417 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Kentucky
Vaccinated:2000-09-22
Onset:2000-09-24
Submitted:2000-10-03
Entered:2000-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467010 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0554K / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0554K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1433 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Adrenal disorder, Pulmonary congestion, Pulmonary oedema, Renal disorder, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-24
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': KY2000033

Write-up: The reported states "Don''t know", understands the infant was DOA at the hospital but was not verified. Autopsy also states pulmonary edema, lung congestion, kidney congestion, congestion of adrenals. Cause of death given as sudden infant death syndrome.

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