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This is VAERS ID 162552

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162552
VAERS Form:
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467007 / 0 LL / IM
HBHEPB: COMVAX / MSD 1291K / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD T0395 / 0 RL / IM
PNC: PREVNAR / LEDERLE 472043 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.


Changed on 12/8/2009

VAERS ID: 162552 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-27 2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 467007 / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1291K / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. T0395 / 0 RL / IM
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 472043 / 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:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS. .


Changed on 3/2/2010

VAERS ID: 162552 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 467007 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 472043 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS. .


Changed on 4/7/2010

VAERS ID: 162552 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 467007 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 472043 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS. .


Changed on 5/14/2017

VAERS ID: 162552 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 467007 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 472043 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS. .


Changed on 9/14/2017

VAERS ID: 162552 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 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:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.


Changed on 2/14/2018

VAERS ID: 162552 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.


Changed on 6/14/2018

VAERS ID: 162552 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.


Changed on 8/14/2018

VAERS ID: 162552 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.


Changed on 9/14/2018

VAERS ID: 162552 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.


Changed on 10/14/2018

VAERS ID: 162552 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Nebraska
Vaccinated:2000-10-25
Onset:2000-10-26
Submitted:2000-11-20
Entered:2000-11-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467007 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1291K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0395 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472043 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: Death was caused by SIDS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=162552&WAYBACKHISTORY=ON


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