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This is VAERS ID 155775

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 155775
VAERS Form:
Age:1.3
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS U0173CA / 3 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS UA481AA / 3 RL / IM
IPV: IPV / MERIEUX INST R06172 / 3 RL / SC
MMR: MMR II / MSD 1268J / 0 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death.


Changed on 12/8/2009

VAERS ID: 155775 Before After
VAERS Form:
Age:1.3
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-30 2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES U0173CA / 3 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES UA481AA / 3 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R06172 / 3 RL / SC
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1268J / 0 RL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Respiratory arrest, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 2/14/2017

VAERS ID: 155775 Before After
VAERS Form:
Age:1.3 1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 3 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 3 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 3 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 0 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 9/14/2017

VAERS ID: 155775 Before After
VAERS Form:(blank) 1
Age:1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 3 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 3 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 3 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 0 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 2/14/2018

VAERS ID: 155775 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 6/14/2018

VAERS ID: 155775 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 8/14/2018

VAERS ID: 155775 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 9/14/2018

VAERS ID: 155775 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.


Changed on 10/14/2018

VAERS ID: 155775 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:New Mexico
Vaccinated:2000-06-09
Onset:2000-06-17
Submitted:2000-06-20
Entered:2000-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0173CA / 4 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES UA481AA / 4 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R06172 / 4 RL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1268J / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-06-19
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: Allergic rhinitis, eczema
Preexisting Conditions: 4 1/2 weeks premature
Allergies:
Diagnostic Lab Data: Body sent for autopsy
CDC 'Split Type':

Write-up: Sudden onset of respiratory arrest and subsequent brain death. 07/27/2000 final autopsy report not get typed but findings are:Aucal herniation 2 degree to: 1. diffuse cerbral edema 2 degree 2. Severe micro vesicular for steotosis metabolic enephalopathy. Reye''s Syndrome still susoected but apparently injection of ASA has not been verified. MD still considered it a toxic event. Typed report should be available in about 1 week.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=155775&WAYBACKHISTORY=ON


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