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This is VAERS ID 178718

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 178718
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABS V0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MSD 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   T1390 / 0 - / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 475385 / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: SIDS, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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:
Current Illness:
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS
CDC 'Split Type':

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother"and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possi


Changed on 12/30/2006

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABS V0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MSD 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   T1390 / 0 - / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 475385 / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: SIDS, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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:
Current Illness:
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS
CDC 'Split Type':

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother"and child''''s mothe"r and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possi pos


Changed on 12/8/2009

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES V0537AB U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   AVENTIS PASTEUR T1390 / 0 - / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 475385 476385 / 0 - / IM

Administered by: Other Private      Purchased by: Unknown Other
Symptoms: Apnoea, Asphyxia, SIDS, White blood cell count decreased, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': (blank) WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''''s mothe"r child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was pos possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for s


Changed on 3/2/2010

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T1390 / 0 - / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 476385 / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for s


Changed on 4/7/2010

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T1390 / 0 - / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 476385 / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for s


Changed on 2/13/2013

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR SANOFI PASTEUR T1390 / 0 - / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 476385 / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for s streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 6/14/2014

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 0 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 3/14/2015

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 0 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 2/14/2017

VAERS ID: 178718 Before After
VAERS Form:
Age:0.2 0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 0 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 0 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 9/14/2017

VAERS ID: 178718 Before After
VAERS Form:(blank) 1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 0 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 0 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 0 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 2/14/2018

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 6/14/2018

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 8/14/2018

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 9/14/2018

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 10/14/2018

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 12/24/2020

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 12/30/2020

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 5/7/2021

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.


Changed on 5/21/2021

VAERS ID: 178718 Before After
VAERS Form:1
Age:0.16
Sex:Female
Location:Utah
Vaccinated:2001-09-27
Onset:2001-10-14
Submitted:2002-03-19
Entered:2001-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES U0537AB / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 0776L / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1390 / 1 - / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 476385 / 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Apnoea, Asphyxia, White blood cell count decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-10-14
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: UNK
Current Illness: NONE
Preexisting Conditions: Premature baby, poor weight gain
Allergies:
Diagnostic Lab Data: CFS culture-neg, Blood culture-neg, Culture NOS-neg, Autopsy results-SIDS vs. Asphyxia; WBC-3,000
CDC 'Split Type': WAES0201USA00430

Write-up: A pediatrician reported that a 2 month old female received a dose of Prevnar, DTaP, Comvax and IPV vaccines on 27-SEP-2001. On 14-OCT-2001, at the age of three months, the child was found apneic. Resuscitation measures were performed by the child''s mother and by emergency personnel prior to transporting the child to a local ER where she was pronounced dead. Bacterial CSF and blood and viral culture samples yielded negative results. An autopsy returned inconclusive but sudden infant death syndrome was possible. This report of a serious, labeled event is being submitted in a 15-day time frame as requested by the FDA. COD as per autopsy report -- undetermined. Follow-up info from a physician stated that her practice, "did not have any concerns regarding the haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that this pt, who was previously healthy, received haemophilus b conjugate vaccine hepatitis b vaccine recombinant. Additional info from a nurse in the physician''s office stated that another infant (WAES 0203USA00661) also received Hib + Hep-B (lot 638216/1539K) and Prevnar and died of SIDS. The physician''s office reported that they did not believe there was any association with Hib + Hep-B, but that both infants received the same lot of Prevnar. This report was also received from the Center for Biologics and Evaluation and Research and was assigned Vaers Id 180019. F/U info noted that there was no illness at the time of vaccination. The pt died of apparent SIDS, 2 1/2 weeks, post vax. The autopsy report was SIDS vs. anphyxia. The reporter listed the cause of death as SIDS. No further information is available. The follow up info received on 12/30/02 indicated that the pt''s birth weight was 4 lbs 15 oz, it was also reported that the pt was a "second twin," had hyyperglycemia, hyperbilirubinemia and was premature at 35 weeks gestation. No further info is available. Follow up on 10/20/2003: "This report was received from Wyeth Ayerst for streptococcus pneumoniae vaccine (Prevnar) and assigned manufacturer report number HQ9063604DEC2001 (also noted to be HQ9063504NOV2001, HQ7304118OCT2001 & HQ0646611FEB2002). This report is concerning a 10 week old female." A 15-day report received 10/24/2003 adds no new info.

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