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This is VAERS ID 161853

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 161853
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 918A2 / 0 LL / IM
HBHEPB: COMVAX / MSD 0298K / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD R0668 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type':

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 12/8/2009

VAERS ID: 161853 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 918A2 / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0298K / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R0668 / 0 LL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Cardiac arrest, SIDS, Sudden infant death syndrome, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': (blank) MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 5/14/2017

VAERS ID: 161853 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 0 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 9/14/2017

VAERS ID: 161853 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 0 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 2/14/2018

VAERS ID: 161853 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 6/14/2018

VAERS ID: 161853 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 8/14/2018

VAERS ID: 161853 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 9/14/2018

VAERS ID: 161853 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.


Changed on 10/14/2018

VAERS ID: 161853 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2000-10-03
Onset:2000-10-09
Submitted:2000-11-06
Entered:2000-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 918A2 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0298K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0668 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-09
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: premature birth, twin
Allergies:
Diagnostic Lab Data: Autopsy - SIDS
CDC 'Split Type': MS00043

Write-up: The pt was presented to the ER on 10/9/00 in cardiopulmonary arrest. This occurred 6 days post vax. A full autopsy was performed and cause of death is SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=161853&WAYBACKHISTORY=ON


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