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This is VAERS ID 162585

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162585
VAERS Form:
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0328AB / 0 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA546AA / 0 RL / IM

Administered by: Other      Purchased by: Unknown
Symptoms: APNEA, ACIDOSIS, HEART ARREST, HEART FAIL, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory fai"lure secondary to congenital heart failure.


Changed on 12/8/2009

VAERS ID: 162585 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0328AB / 0 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA546AA / 0 RL / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure, APNEA, ACIDOSIS, HEART ARREST, HEART FAIL, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory fai"lure failure secondary to congenital heart failure.


Changed on 9/14/2017

VAERS ID: 162585 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 0 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 0 1 RL / IM

Administered by: Other      Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


Changed on 2/14/2018

VAERS ID: 162585 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other      Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


Changed on 6/14/2018

VAERS ID: 162585 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other      Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


Changed on 8/14/2018

VAERS ID: 162585 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other      Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


Changed on 9/14/2018

VAERS ID: 162585 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other      Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.


Changed on 10/14/2018

VAERS ID: 162585 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:Pennsylvania
Vaccinated:2000-10-23
Onset:2000-10-23
Submitted:2000-11-17
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0328AB / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA546AA / 1 RL / IM

Administered by: Other      Purchased by: Other
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Malaise, Pulmonary congestion, Respiratory failure

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-23
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: diuretics, Zantac
Current Illness: CHF
Preexisting Conditions: complex cyanotic heart disease, chronic lung disease
Allergies:
Diagnostic Lab Data: chest x-ray, blood gases, autopsy (heart and lungs)
CDC 'Split Type':

Write-up: 28 4/7 weeks premature infant was given vaccines on 10/23/00 at approximately 9:00. At 12:00 the infant had signs of decreased profusion, shock, malaise, acidosis, and cardiac arrest. Autopsy shows lung congestion. Death stated as caused by repiratory failure secondary to congenital heart failure.

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