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This is VAERS ID 162748

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 162748
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 462354 / 0 RL / IM
HBHEPB: COMVAX / MSD 0296K / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD T0117 / 0 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


Changed on 12/8/2009

VAERS ID: 162748 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-30 2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 462354 / 0 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0296K / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. T0117 / 0 RL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Pneumonia, Unevaluable event, REACT UNEVAL, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia. 2


Changed on 5/14/2017

VAERS ID: 162748 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 462354 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 0 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia. 2


Changed on 9/14/2017

VAERS ID: 162748 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 0 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


Changed on 2/14/2018

VAERS ID: 162748 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


Changed on 6/14/2018

VAERS ID: 162748 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


Changed on 8/14/2018

VAERS ID: 162748 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


Changed on 9/14/2018

VAERS ID: 162748 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.


Changed on 10/14/2018

VAERS ID: 162748 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Michigan
Vaccinated:2000-09-18
Onset:2000-09-20
Submitted:2000-11-20
Entered:2000-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 462354 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0296K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. T0117 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-09-20
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: Poly-Vi-Sol, Fer-In-Sol
Current Illness: URI
Preexisting Conditions: 32 week prematurity, retinopathy of prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The pt died approximately 36 hours after receiving the immunizations. Cause of death is unknown. Autopsy states the cause of death as pneumonia.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=162748&WAYBACKHISTORY=ON


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