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This is VAERS ID 174843

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 174843
VAERS Form:
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (UNKNOWN MFR) / UNCLASSIFIED - / - - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE - / - - / IM
VARCEL: VARICELLA (VARIVAX) / MSD - / - - / SC

Administered by: Other      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: Autopsy report was negative
CDC 'Split Type':

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The"child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 12/8/2009

VAERS ID: 174843 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-09-04 2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (UNKNOWN MFR) MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER - / - - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES - / - - / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MSD MERCK & CO. INC. - / - - / SC

Administered by: Other      Purchased by: Unknown Other
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: NONE Autopsy report was negative
Preexisting Conditions: UNK NONE
Allergies:
Diagnostic Lab Data: Autopsy report was negative UNK
CDC 'Split Type': (blank) HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The"child The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 3/2/2010

VAERS ID: 174843 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES - / - - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 4/7/2010

VAERS ID: 174843 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES - / - - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 5/14/2017

VAERS ID: 174843 Before After
VAERS Form:
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH - / - - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 9/14/2017

VAERS ID: 174843 Before After
VAERS Form:(blank) 1
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / - UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UNK - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 2/14/2018

VAERS ID: 174843 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 6/14/2018

VAERS ID: 174843 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 8/14/2018

VAERS ID: 174843 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 9/14/2018

VAERS ID: 174843 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.


Changed on 10/14/2018

VAERS ID: 174843 Before After
VAERS Form:1
Age:1.4
Sex:Female
Location:Colorado
Vaccinated:2000-10-18
Onset:2000-10-26
Submitted:2001-08-28
Entered:2001-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH - / UNK - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / SC

Administered by: Other      Purchased by: Other
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-10-26
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: UNK
Current Illness: Autopsy report was negative
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': HQ5280128AUG2001

Write-up: A pediatrician reported that a 17 month old female received injections of Prevnar, MMR, and varicella vaccines on 10/18/2000. She was noted to be a healthy child with no past history of illness and no pre-exititng illness at this time of vaccination. The child was found dead in her crib on 10/26/2000. Sudden Infant Death Syndrome was reported. An autopsy was reported to be negative. NOTE: this report of a serious, labeled event (SIDS) is being submitted in a 15 day time frame as requested by the FDA.

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