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This is VAERS ID 161756

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161756
VAERS Form:
Age:0.8
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PREVNAR / LEDERLE 4712149 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, DYSPNEA, INTRACRAN HYPERTENS, HYPOXIA, INFECT BACT

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pup"il. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 12/30/2006

VAERS ID: 161756 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PREVNAR / LEDERLE 4712149 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: FEVER, DYSPNEA, INTRACRAN HYPERTENS, HYPOXIA, INFECT BACT

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s physician''''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pup"il. pu"pil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 12/8/2009

VAERS ID: 161756 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 4712149 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection, FEVER, DYSPNEA, INTRACRAN HYPERTENS, HYPOXIA, INFECT BACT

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''''s physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pu"pil. pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 3/2/2010

VAERS ID: 161756 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 4712149 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 4/7/2010

VAERS ID: 161756 Before After
VAERS Form:
Age:0.8
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 4712149 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 2/14/2017

VAERS ID: 161756 Before After
VAERS Form:
Age:0.8 0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 4712149 / 0 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 9/14/2017

VAERS ID: 161756 Before After
VAERS Form:(blank) 1
Age:0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 0 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 2/14/2018

VAERS ID: 161756 Before After
VAERS Form:1
Age:0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 6/14/2018

VAERS ID: 161756 Before After
VAERS Form:1
Age:0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 8/14/2018

VAERS ID: 161756 Before After
VAERS Form:1
Age:0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 9/14/2018

VAERS ID: 161756 Before After
VAERS Form:1
Age:0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.


Changed on 10/14/2018

VAERS ID: 161756 Before After
VAERS Form:1
Age:0.75
Sex:Male
Location:Kentucky
Vaccinated:2000-07-03
Onset:2000-07-19
Submitted:2000-11-05
Entered:2000-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 4712149 / 1 LL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Coma, Dyspnoea, Fontanelle bulging, Hypoxia, Mydriasis, Pneumonia, Pyrexia, Rash, Vomiting, Bacterial infection

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2000-07-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Motrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: sepsis work-up, CSF culture showed strep pneumoniae; CSF was sent to CDC where it was sterotyped as #14, which is a sterotyped contained in Prevnar
CDC 'Split Type':

Write-up: On 7/19, the pt developed a fever and rash on face. On 7/20, the fever continued. On 7/21, the pt developed vomiting and fever. Then later on 7/21, seen at physician''s office with unresponsiveness, forced respirations, bulging fontanelle, dilated left pupil. Pt transferred by ambulance to hospital where pt was intubated. En route to CT, the pt was coded and eventually expired on 7/22.

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