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This is VAERS ID 161164

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161164
VAERS Form:
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0317BB / 0 LL / IM
HBHEPB: COMVAX / MSD 0785K / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD T01202 / 0 RL / SC
PNC: PREVNAR / LEDERLE 472042 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, SOMNOLENCE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS.


Changed on 12/8/2009

VAERS ID: 161164 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0317BB / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0785K / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. T01202 / 0 RL / SC
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 472042 / 0 LL / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asphyxia, SIDS, Somnolence, Sudden infant death syndrome, SOMNOLENCE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 3/2/2010

VAERS ID: 161164 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 472042 / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 4/7/2010

VAERS ID: 161164 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 472042 / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 5/14/2017

VAERS ID: 161164 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 472042 / 0 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 9/14/2017

VAERS ID: 161164 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 0 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 2/14/2018

VAERS ID: 161164 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 6/14/2018

VAERS ID: 161164 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 8/14/2018

VAERS ID: 161164 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 9/14/2018

VAERS ID: 161164 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.


Changed on 10/14/2018

VAERS ID: 161164 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Minnesota
Vaccinated:2000-09-22
Onset:2000-09-26
Submitted:2000-10-18
Entered:2000-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0317BB / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0785K / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T01202 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472042 / 1 LL / IM

Administered by: Private      Purchased by: Private
Symptoms: Asphyxia, Somnolence, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-26
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:
CDC 'Split Type':

Write-up: The pt slept more for the first 2 days post vax. The pt died with a diagnosis of SIDS. Follow-up information received on 12/02/2002 from the autopsy report indicates the pt had position asphyxia.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161164&WAYBACKHISTORY=ON


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