National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 178757

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 178757
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) /   UO536CA / 0 LL / -
HBPV: HIB (HIBIMUNE) / LEDERLE 480935 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   T1031 / 0 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 480395 / 0 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 12/8/2009

VAERS ID: 178757 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) /   AVENTIS PASTEUR UO536CA / 0 LL / -
HBPV: HIB (HIBIMUNE) HIB POLYSACCHARIDE (HIBIMUNE) / LEDERLE LEDERLE LABORATORIES 480935 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   AVENTIS PASTEUR T1031 / 0 RL / -
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 480395 / 0 RL / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Cardiac arrest, SIDS, Sudden infant death syndrome, HEART ARREST

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 3/2/2010

VAERS ID: 178757 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR UO536CA / 0 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / LEDERLE LABORATORIES 480935 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T1031 / 0 RL / -
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 480395 / 0 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 4/7/2010

VAERS ID: 178757 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR UO536CA / 0 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / LEDERLE LABORATORIES 480935 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T1031 / 0 RL / -
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 480395 / 0 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 5/14/2017

VAERS ID: 178757 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR SANOFI PASTEUR UO536CA / 0 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 480935 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR SANOFI PASTEUR T1031 / 0 RL / -
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 480395 / 0 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 9/14/2017

VAERS ID: 178757 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 0 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 0 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 0 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 2/14/2018

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 6/14/2018

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 8/14/2018

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 9/14/2018

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 10/14/2018

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 12/24/2020

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 12/30/2020

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 5/7/2021

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr


Changed on 5/21/2021

VAERS ID: 178757 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:North Carolina
Vaccinated:2001-11-28
Onset:2001-11-29
Submitted:2001-11-29
Entered:2001-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR UO536CA / 1 LL / -
HBPV: HIB POLYSACCHARIDE (HIBIMUNE) / PFIZER/WYETH 480935 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T1031 / 1 RL / -
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 480395 / 1 RL / -

Administered by: Private      Purchased by: Public
Symptoms: Cardiac arrest, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Post mortem exam
CDC 'Split Type':

Write-up: Pt found asystolic at approximately 2 AM in his crib on 11/29/2001. COD as per autopsy report --SIDS/sr

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=178757&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166