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This is VAERS ID 178823

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 178823
VAERS Form:
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE 484131 / 1 LL / IM

Administered by: Public      Purchased by: Unknown
Symptoms: VOMIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 12/8/2009

VAERS ID: 178823 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LEDERLE LABORATORIES 484131 / 1 LL / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Vomiting, VOMIT

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': (blank) OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 3/2/2010

VAERS ID: 178823 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 484131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 4/7/2010

VAERS ID: 178823 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 484131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 5/14/2017

VAERS ID: 178823 Before After
VAERS Form:
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 484131 / 1 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 9/14/2017

VAERS ID: 178823 Before After
VAERS Form:(blank) 1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 1 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 2/14/2018

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 6/14/2018

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 8/14/2018

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 9/14/2018

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 10/14/2018

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 12/24/2020

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 12/30/2020

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 5/7/2021

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.


Changed on 5/21/2021

VAERS ID: 178823 Before After
VAERS Form:1
Age:2.0
Sex:Female
Location:Ohio
Vaccinated:2001-11-14
Onset:2001-11-17
Submitted:2001-11-29
Entered:2001-12-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 484131 / 2 LL / IM

Administered by: Public      Purchased by: Public
Symptoms: Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-11-17
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': OH0071

Write-up: The evening of 11/16/01, the child vomited X 1 and no other symptoms were present. The child died in her sleep that night. Cause of Death as per autopsy report was SIDS with focal epiglotitis.

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