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This is VAERS ID 160877

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 160877
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0317BB / 0 - / IM
HEP: RECOMBIVAX HB / MSD 1031K / 0 - / IM
PNC: PREVNAR / LEDERLE 473809 / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, STUPOR, INFECT BACT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 12/8/2009

VAERS ID: 160877 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-26 2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0317BB / 0 - / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1031K / 0 - / IM
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 473809 / 0 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Coma, Pyrexia, Bacterial infection, FEVER, STUPOR, INFECT BACT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 3/2/2010

VAERS ID: 160877 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 0 - / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 473809 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 4/7/2010

VAERS ID: 160877 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 0 - / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 473809 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 2/14/2017

VAERS ID: 160877 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 0 - / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 473809 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 9/14/2017

VAERS ID: 160877 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 0 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 0 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 2/14/2018

VAERS ID: 160877 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 6/14/2018

VAERS ID: 160877 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 8/14/2018

VAERS ID: 160877 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 9/14/2018

VAERS ID: 160877 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.


Changed on 10/14/2018

VAERS ID: 160877 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Virginia
Vaccinated:2000-10-05
Onset:2000-10-06
Submitted:2000-10-18
Entered:2000-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 - / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1031K / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Coma, Pyrexia, Bacterial infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-08
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: phenobarbitol, Lasix, Digoxin
Current Illness:
Preexisting Conditions: status post stage I of hypoplastic left heart syndrome
Allergies:
Diagnostic Lab Data: blood culture-pneumococcus
CDC 'Split Type':

Write-up: 20 hours post vax, the pt had a fever of 100. 72 hours post vax, the pt arrived unresponsive to ER and died during resuscitative efforts. A blood culture grew pneumococcus. Child was status post stage I surgery for hypoplastic left heart syndrome.

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