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This is VAERS ID 162587

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162587
VAERS Form:
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 469397 / 0 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA523AA / 0 LL / IM
IPV: IPV / MERIEUX INST T0025 / 0 RL / IM
PNC: PREVNAR / LEDERLE 472549 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, AGITATION, APNEA, LUNG DIS, LIVER DAMAGE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, live"r congestion


Changed on 12/8/2009

VAERS ID: 162587 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 469397 / 0 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA523AA / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. T0025 / 0 RL / IM
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 472549 / 0 RL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, SIDS, Sudden infant death syndrome, AGITATION, APNEA, LUNG DIS, LIVER DAMAGE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, live"r liver congestion 2


Changed on 3/2/2010

VAERS ID: 162587 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 469397 / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 472549 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion 2


Changed on 4/7/2010

VAERS ID: 162587 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 469397 / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 472549 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion 2


Changed on 5/14/2017

VAERS ID: 162587 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 469397 / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 472549 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion 2


Changed on 9/14/2017

VAERS ID: 162587 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 0 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 0 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


Changed on 2/14/2018

VAERS ID: 162587 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


Changed on 6/14/2018

VAERS ID: 162587 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


Changed on 8/14/2018

VAERS ID: 162587 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


Changed on 9/14/2018

VAERS ID: 162587 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion


Changed on 10/14/2018

VAERS ID: 162587 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:South Carolina
Vaccinated:2000-11-09
Onset:2000-11-10
Submitted:2000-11-22
Entered:2000-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469397 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA523AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. T0025 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 472549 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Apnoea, Coma, Liver disorder, Pulmonary congestion, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-10
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: jaundice (newborn), pneumothorax
Allergies:
Diagnostic Lab Data: autopsy - pending
CDC 'Split Type':

Write-up: The mother states the child was crying around 2 am on 11/10/00. She placed him in his bed and found him unresponsive and not breathing at 6:00 am. Child was pronounced DOA. Autopsy states sudden infant death syndrome. Also shows pulmonary congetsion, liver congestion

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