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This is VAERS ID 161215

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161215
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 469395 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 560753A / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD 0444 / 1 - / SC
PNC: PREVNAR / LEDERLE 4712151 / - RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 12/8/2009

VAERS ID: 161215 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-06 2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 469395 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 560753A / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. 0444 / 1 - / SC
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 4712151 / - RL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 3/2/2010

VAERS ID: 161215 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 469395 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 560753A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 1 - / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 4712151 / - RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 4/7/2010

VAERS ID: 161215 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 469395 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 560753A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 1 - / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 4712151 / - RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 2/14/2017

VAERS ID: 161215 Before After
VAERS Form:
Age:0.3 0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 469395 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 560753A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 1 - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES 4712151 / - RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 5/14/2017

VAERS ID: 161215 Before After
VAERS Form:
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 469395 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 560753A / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 1 - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 4712151 / - RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 9/14/2017

VAERS ID: 161215 Before After
VAERS Form:(blank) 1
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 1 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / - UNK RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 2/14/2018

VAERS ID: 161215 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 6/14/2018

VAERS ID: 161215 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 8/14/2018

VAERS ID: 161215 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 9/14/2018

VAERS ID: 161215 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.


Changed on 10/14/2018

VAERS ID: 161215 Before After
VAERS Form:1
Age:0.25
Sex:Male
Location:Indiana
Vaccinated:2000-07-24
Onset:2000-07-25
Submitted:2000-10-27
Entered:2000-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469395 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 560753A / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 0444 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712151 / UNK RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Apnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-07-25
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: Raglan, Pantidne
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Found not breathing that night. Taken to ER, transferred to another hospital. Pronounced dead at 3:00 am.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161215&WAYBACKHISTORY=ON


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