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This is VAERS ID 165922

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 165922
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE(PRAXIS) 581253 / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD 0580K / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 475382 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MSD 1249K / 0 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: HEART ARREST, ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


Changed on 12/8/2009

VAERS ID: 165922 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS 581253 / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 0580K / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 475382 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1249K / 0 LL / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Cardio-respiratory arrest, Encephalopathy, HEART ARREST, ENCEPHALOPATHY

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy. 3


Changed on 3/2/2010

VAERS ID: 165922 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 581253 / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 475382 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 0 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy. 3


Changed on 4/7/2010

VAERS ID: 165922 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS 581253 / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 475382 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 0 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy. 3


Changed on 5/14/2017

VAERS ID: 165922 Before After
VAERS Form:
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH 581253 / 2 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 0 RL / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 475382 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 0 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy. 3


Changed on 9/14/2017

VAERS ID: 165922 Before After
VAERS Form:(blank) 1
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 2 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 1 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 0 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


Changed on 2/14/2018

VAERS ID: 165922 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


Changed on 6/14/2018

VAERS ID: 165922 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


Changed on 8/14/2018

VAERS ID: 165922 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


Changed on 9/14/2018

VAERS ID: 165922 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.


Changed on 10/14/2018

VAERS ID: 165922 Before After
VAERS Form:1
Age:1.0
Sex:Male
Location:Florida
Vaccinated:2000-12-12
Onset:0000-00-00
Submitted:2001-02-13
Entered:2001-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBTITER) / PFIZER/WYETH 581253 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0580K / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475382 / 2 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1249K / 1 LL / SC

Administered by: Private      Purchased by: Public
Symptoms: Cardio-respiratory arrest, Encephalopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-12-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, albuterol
Current Illness: Gastroenteritis
Preexisting Conditions: Chronic lung disease; prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This infant died of cardiopulmonary arrest of unknown etiology; at this time autopsy is pending. Autopsy stated cause of death as acute encephalopathy.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=165922&WAYBACKHISTORY=ON


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