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This is VAERS ID 121059

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 121059
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 457789 / 0 RL / IM
HBHEPB: COMVAX / MSD 1615H / - LL / IM
IPV: POLIOVAX / CONNAUGHT LTD M129H / - L / SC

Administered by: Private      Purchased by: Unknown
Symptoms: PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 12/8/2009

VAERS ID: 121059 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-12 1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 457789 / 0 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1615H / - LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M129H / - L / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Pneumonia, PNEUMONIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 5/14/2017

VAERS ID: 121059 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 457789 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / - LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / - L - / SC SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 9/14/2017

VAERS ID: 121059 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / - UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / - UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 2/14/2018

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 6/14/2018

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 8/14/2018

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 9/14/2018

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 10/14/2018

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 12/24/2020

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 12/30/2020

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 5/7/2021

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;


Changed on 5/21/2021

VAERS ID: 121059 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:1999-03-26
Onset:1999-04-02
Submitted:1999-04-02
Entered:1999-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 457789 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1615H / UNK LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M129H / UNK - / SC L

Administered by: Private      Purchased by: Public
Symptoms: Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-04-02
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: had RSV infect 2MAR99;
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS death 7 days p/vax;

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