National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 162631

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162631
VAERS Form:
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTAP96042 / 0 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) 473007 / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD R0691 / 0 RL / IM
PNC: PREVNAR / LEDERLE 473337 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 12/8/2009

VAERS ID: 162631 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM DTAP96042 96042 / 0 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES 473007 / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. R0691 / 0 RL / IM
PNC: PREVNAR PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 473337 / 0 RL / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 3/2/2010

VAERS ID: 162631 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 473007 / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 473337 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 4/7/2010

VAERS ID: 162631 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 473007 / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 473337 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 5/14/2017

VAERS ID: 162631 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 473007 / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 0 RL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 473337 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 9/14/2017

VAERS ID: 162631 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 0 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 2/14/2018

VAERS ID: 162631 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 6/14/2018

VAERS ID: 162631 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 8/14/2018

VAERS ID: 162631 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 9/14/2018

VAERS ID: 162631 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.


Changed on 10/14/2018

VAERS ID: 162631 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Michigan
Vaccinated:2000-11-14
Onset:2000-11-15
Submitted:2000-11-20
Entered:2000-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 96042 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 473007 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. R0691 / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 473337 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-11-15
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: NONE
Allergies:
Diagnostic Lab Data: autopsy - nml
CDC 'Split Type':

Write-up: The pt died from SIDS within 24 hours post vax.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=162631&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166