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This is VAERS ID 179886

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 179886
VAERS Form:
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, U037AA / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR, T0595 / 0 - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATO 475385 / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type':

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This i"s 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 12/8/2009

VAERS ID: 179886 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR, AVENTIS PASTEUR U037AA / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR, AVENTIS PASTEUR T0595 / 0 - / SC
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATO LEDERLE LABORATORIES 475385 / 0 - / IM

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

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': (blank) HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This i"s is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 3/2/2010

VAERS ID: 179886 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR U037AA / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T0595 / 0 - / SC
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 475385 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 4/7/2010

VAERS ID: 179886 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR U037AA / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T0595 / 0 - / SC
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 475385 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 5/14/2017

VAERS ID: 179886 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / AVENTIS PASTEUR SANOFI PASTEUR U037AA / 0 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR SANOFI PASTEUR T0595 / 0 - / SC
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 475385 / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 9/14/2017

VAERS ID: 179886 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 0 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 0 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 0 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 2/14/2018

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 6/14/2018

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 8/14/2018

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 9/14/2018

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 10/14/2018

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 12/24/2020

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 12/30/2020

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 5/7/2021

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.


Changed on 5/21/2021

VAERS ID: 179886 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Utah
Vaccinated:2001-10-11
Onset:2001-10-13
Submitted:2002-01-03
Entered:2002-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U037AA / 1 - / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1591K / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0595 / 1 - / SC
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 475385 / 1 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Sudden infant death syndrome

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)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Prematurity; twin pregnancy, hyperbilirubinaemia, hypoglycaemia NOS
Allergies:
Diagnostic Lab Data: Autopsy results-pending
CDC 'Split Type': HQ7285218OCT2001

Write-up: A physician reported that a 2 month old infant received an injection of Prevnar (first dose) on 11-OCT-2001. Subsequently, the pt was hospitalized and on 14-OCT-2001, the infant died. No further information was available at the date of this report. This is 1 of 2 pts from this facility who died after receipt of Prevnar lot 475-385. Cause of Death as per autopsy report was SIDS. Initial autopsy showed no cause of death. Final results were not received. The reporter noted that this was the healthier twin.

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