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This is VAERS ID 161299

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161299
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0328BA / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 471875 / 0 RL / IM
PNC: PREVNAR / LEDERLE 473809 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 12/8/2009

VAERS ID: 161299 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-06 2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0328BA / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 471875 / 0 RL / IM
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 473809 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 3/2/2010

VAERS ID: 161299 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 471875 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 473809 / 0 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 4/7/2010

VAERS ID: 161299 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 471875 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 473809 / 0 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 2/14/2017

VAERS ID: 161299 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 471875 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 473809 / 0 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 9/14/2017

VAERS ID: 161299 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 0 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 2/14/2018

VAERS ID: 161299 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 6/14/2018

VAERS ID: 161299 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 8/14/2018

VAERS ID: 161299 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 9/14/2018

VAERS ID: 161299 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS


Changed on 10/14/2018

VAERS ID: 161299 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-25
Onset:0000-00-00
Submitted:2000-11-02
Entered:2000-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328BA / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 471875 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473809 / 1 RL / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-02
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: Tylenol
Current Illness:
Preexisting Conditions: born at 39 3/7 weeks gestation - twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was in for a well child exam and immunizations on 10/25/00. Infant died on 10/27/00. Cause of Death SIDS

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161299&WAYBACKHISTORY=ON


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