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This is VAERS ID 160612

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 160612
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: UNK. DTAP / UNCLASSIFIED 7HB1507 / 0 - / IM
HEP: UNK. HEPATITIS B / UNCLASSIFIED 00727 / 0 - / IM
HIBV: UNK. HAEMOPHILUS B / UNCLASSIFIED M305PB / 0 - / IM
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT / UNCLASSIFIED - / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: AGITATION, CONVULS, APNEA, DIARRHEA, CRY ABNORMAL

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, re"suscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 12/8/2009

VAERS ID: 160612 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-18 2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: UNK. DTAP DTAP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 7HB1507 / 0 - / IM
HEP: UNK. HEPATITIS B HEP B (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 00727 / 0 - / IM
HIBV: UNK. HAEMOPHILUS B HIB (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER M305PB / 0 - / IM
OPV: UNK. POLIOVIRUS LIVE ORAL TRIVALENT POLIO VIRUS, ORAL (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / 0 - / PO

Administered by: Private      Purchased by: Unknown Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Platelet count increased, High-pitched crying, AGITATION, CONVULS, APNEA, DIARRHEA, CRY ABNORMAL

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, re"suscitated, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 5/14/2017

VAERS ID: 160612 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 0 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 0 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 0 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 9/14/2017

VAERS ID: 160612 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 0 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 0 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 0 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 2/14/2018

VAERS ID: 160612 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 6/14/2018

VAERS ID: 160612 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 8/14/2018

VAERS ID: 160612 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 9/14/2018

VAERS ID: 160612 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.


Changed on 10/14/2018

VAERS ID: 160612 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Florida
Vaccinated:1997-11-11
Onset:1997-11-12
Submitted:2000-10-10
Entered:2000-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER 7HB1507 / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 00727 / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER M305PB / 1 - / IM
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 MO / PO

Administered by: Private      Purchased by: Other
Symptoms: Agitation, Apnoea, Blood glucose increased, Cerebral haemorrhage, Cerebral ischaemia, Convulsion, Diarrhoea, Feeding disorder neonatal, Grunting, Hypoxia, Lethargy, Liver function test abnormal, Meningitis, Pneumonia, Pyrexia, Respiratory arrest, Platelet count increased, High-pitched crying

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:1997-11-29
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pedialyte, Children''s Tylenol
Current Illness: Pneumonia, unresolved RDS, Meningeal infection
Preexisting Conditions: Prematurity, RDS, Hyperbilirubinemia, Gestational diabetes, induced labor, E-Coli, others, meningeal infection, failure to thrive, NRBC''s
Allergies:
Diagnostic Lab Data: Hematological, UA, Chemical Profile, coagulation, culture, Glucose increased, liver-increased multiple abnormalties, Platelet increased, Anion Gap increased, Creatine decreased, Phos increased, and many more.
CDC 'Split Type':

Write-up: Fever, apnea, vomiting, diarrhea, feeding problems, grunting, high-pitched crying, possible seizures, lethargy with onset at 24 to 48 hours, possibly sooner. 10 days later, symptoms worsening gradually. At 10:00 on 11/24/1997, pt in respiratory arrest, resuscitated, life support with CT Scan revealing ICH, DAT, hypoxia, ischemia, pneumonia, meningeal inflection, others. Life support terminated 11/29/1997.

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