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This is VAERS ID 178821

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 178821
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) / UNCLASSIFIED UO151A / 1 - / IM
HEP: HEP B (UNKNOWN MFR) / UNCLASSIFIED 1028K / 1 - / IM
HIBV: HIB (UNKNOWN MFR) / UNCLASSIFIED 1643K / 1 - / IM
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) / UNCLASSIFIED T1390 / 1 - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE T1390 / 1 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: STUPOR, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 12/8/2009

VAERS ID: 178821 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (UNKNOWN MFR) DTAP (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER UO151A / 1 - / IM
HEP: HEP B (UNKNOWN MFR) HEP B (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 1028K / 1 - / IM
HIBV: HIB (UNKNOWN MFR) HIB (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER 1643K / 1 - / IM
IPV: POLIO VIRUS, INACT. (UNKNOWN MFR) POLIO VIRUS, INACT. (NO BRAND NAME) / UNCLASSIFIED UNKNOWN MANUFACTURER T1390 / 1 - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES T1390 / 1 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Apnoea, Coma, STUPOR, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 3/2/2010

VAERS ID: 178821 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 1 - / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES T1390 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 4/7/2010

VAERS ID: 178821 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 1 - / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES T1390 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 5/14/2017

VAERS ID: 178821 Before After
VAERS Form:
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 1 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 1 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 1 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 1 - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH T1390 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 9/14/2017

VAERS ID: 178821 Before After
VAERS Form:(blank) 1
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 1 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 1 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 1 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 1 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 1 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 2/14/2018

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 6/14/2018

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 8/14/2018

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 9/14/2018

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 10/14/2018

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 12/10/2020

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Unknown Maine
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 12/24/2020

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Maine
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 12/30/2020

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Maine
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 5/7/2021

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Maine
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.


Changed on 5/21/2021

VAERS ID: 178821 Before After
VAERS Form:1
Age:
Sex:Female
Location:Maine
Vaccinated:2001-11-12
Onset:2001-11-15
Submitted:2001-12-10
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER UO151A / 2 - / IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1028K / 2 - / IM
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 1643K / 2 - / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER T1390 / 2 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH T1390 / 2 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Apnoea, Coma

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-15
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:
CDC 'Split Type':

Write-up: On 11/15/01 at 01:00, pt was fed and laid on her back. At 03:00, checked baby and determined that she was not breathing. There was no response and no pulse. Called 911 and CRP was performed. Ambulance came and transported to the hospital.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=178821&WAYBACKHISTORY=ON


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