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This is VAERS ID 178822

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 178822
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE DTPA988A2 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MSD 1522K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   R14372 / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 477450 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 12/8/2009

VAERS ID: 178822 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM DTPA988A2 988A2 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1522K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) /   AVENTIS PASTEUR R14372 / 0 RL / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 477450 / 0 LL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, SIDS, Sudden infant death syndrome, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 3/2/2010

VAERS ID: 178822 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR R14372 / 0 RL / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 477450 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 4/7/2010

VAERS ID: 178822 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR R14372 / 0 RL / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 477450 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 5/14/2017

VAERS ID: 178822 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR SANOFI PASTEUR R14372 / 0 RL / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 477450 / 0 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 9/14/2017

VAERS ID: 178822 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 0 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 0 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 2/14/2018

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 6/14/2018

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 8/14/2018

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 9/14/2018

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 10/14/2018

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 12/24/2020

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 12/30/2020

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 5/7/2021

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS


Changed on 5/21/2021

VAERS ID: 178822 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Mississippi
Vaccinated:2001-06-13
Onset:2001-06-13
Submitted:2001-12-03
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 988A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1522K / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR R14372 / 1 RL / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 477450 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-06-13
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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: I was told that the mother placed him in his baby bed around 20:00. About an hour later, when she checked on him, he was not breathing. I was told he died at home. COD as per autopsy report -- SIDS

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