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This is VAERS ID 161415

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161415
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 472653 / - - / -
HBHEPB: COMVAX / MSD 055K / - - / -
IPV: POLIOVAX / CONNAUGHT LTD R1345 / - - / -
PNC: PREVNAR / LEDERLE 471206 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: MENINGITIS, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type':

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 12/8/2009

VAERS ID: 161415 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 472653 / - - / -
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 055K / - - / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R1345 / - - / -
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 471206 / 0 RL / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Meningitis, Pneumonia, MENINGITIS, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': (blank) Or200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 3/2/2010

VAERS ID: 161415 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 472653 / - - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / - - / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 471206 / 0 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': Or200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 4/7/2010

VAERS ID: 161415 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 472653 / - - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / - - / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 471206 / 0 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': Or200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 2/14/2017

VAERS ID: 161415 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 472653 / - - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / - - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / - - / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 471206 / 0 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': Or200037 OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 9/14/2017

VAERS ID: 161415 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / - UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / - UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / - UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 0 1 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 2/14/2018

VAERS ID: 161415 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 6/14/2018

VAERS ID: 161415 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 8/14/2018

VAERS ID: 161415 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 9/14/2018

VAERS ID: 161415 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.


Changed on 10/14/2018

VAERS ID: 161415 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:Oregon
Vaccinated:2000-08-22
Onset:2000-09-27
Submitted:2000-10-07
Entered:2000-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 472653 / UNK - / -
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 055K / UNK - / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R1345 / UNK - / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 471206 / 1 RL / IM

Administered by: Private      Purchased by: Other
Symptoms: Meningitis, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-28
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CSF - pos for pneumococcus
CDC 'Split Type': OR200037

Write-up: The pt developed pneumococcal meningitis resulting in death 36 days post vax.

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