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This is VAERS ID 308149

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 308149
VAERS Form:
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Death, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type':

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 12/8/2009

VAERS ID: 308149 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHE: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 0 RL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Death, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': (blank) NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 3/2/2010

VAERS ID: 308149 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 RL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / WYETH PHARMACEUTICALS, INC C57536 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 4/7/2010

VAERS ID: 308149 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 RL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC C57536 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 8/31/2010

VAERS ID: 308149 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 RL / IM
PNC: PNEUMO (PREVNAR) / WYETH PHARMACEUTICALS, INC PFIZER/WYETH C57536 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 4/14/2017

VAERS ID: 308149 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Sudden infant death syndrome, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 9/14/2017

VAERS ID: 308149 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 1 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 0 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 0 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 2/14/2018

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 6/14/2018

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 8/14/2018

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 9/14/2018

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 10/14/2018

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 12/24/2020

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 12/30/2020

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 5/7/2021

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.


Changed on 5/14/2021

VAERS ID: 308149 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:New Hampshire
Vaccinated:2008-03-13
Onset:2008-03-14
Submitted:2008-03-20
Entered:2008-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B142AJ / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF345AC / 1 RL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH C57536 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2008-03-14
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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: State exam - pending
CDC 'Split Type': NH08

Write-up: Our office was informed 3/14/08 of patients demise - no side effects in office. 5/15/08-records received-Cause of death:Sudden Infant Death Syndrome (SIDS). Manner of death:natural.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=308149&WAYBACKHISTORY=ON

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