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This is VAERS ID 179926

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History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 179926
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECH 525A2 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATO 477385 / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR, T0909 / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) / LEDERLE LABORATO 481815 / 0 RL / IM

Administered by: Private      Purchased by: Unknown
Symptoms: BRAIN SYND ACUTE, CHILLS, LUNG DIS, BIRTH PREMAT, PERINATAL DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows chan"ges in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematuri


Changed on 12/8/2009

VAERS ID: 179926 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECH SMITHKLINE BEECHAM 525A2 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATO LEDERLE LABORATORIES 477385 / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR, AVENTIS PASTEUR T0909 / 0 LL / IM
PNC: PNEUMO, 7-VALENT (PREVNAR) PNEUMO (PREVNAR) / LEDERLE LABORATO LEDERLE LABORATORIES 481815 / 0 RL / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event, BRAIN SYND ACUTE, CHILLS, LUNG DIS, BIRTH PREMAT, PERINATAL DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows chan"ges changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematuri prematurity.


Changed on 3/2/2010

VAERS ID: 179926 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 477385 / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T0909 / 0 LL / IM
PNC: PNEUMO (PREVNAR) PNEUMO (PREVNAR7) / LEDERLE LABORATORIES 481815 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 4/7/2010

VAERS ID: 179926 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES 477385 / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR T0909 / 0 LL / IM
PNC: PNEUMO (PREVNAR7) PNEUMO (PREVNAR) / LEDERLE LABORATORIES 481815 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 5/14/2017

VAERS ID: 179926 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 0 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH 477385 / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / AVENTIS PASTEUR SANOFI PASTEUR T0909 / 0 LL / IM
PNC: PNEUMO (PREVNAR) / LEDERLE LABORATORIES PFIZER/WYETH 481815 / 0 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 9/14/2017

VAERS ID: 179926 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 0 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 0 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 0 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 2/14/2018

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 6/14/2018

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 8/14/2018

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 9/14/2018

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 10/14/2018

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 12/24/2020

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 12/30/2020

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 5/7/2021

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.


Changed on 5/21/2021

VAERS ID: 179926 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Maryland
Vaccinated:2001-12-26
Onset:2001-12-27
Submitted:2001-12-31
Entered:2002-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 525A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 477385 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR T0909 / 1 LL / IM
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH 481815 / 1 RL / IM

Administered by: Private      Purchased by: Public
Symptoms: Feeding disorder neonatal, Feeling cold, Lung disorder, Nervous system disorder, Premature baby, Abnormal sleep-related event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-12-27
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: Fer-In-Sol; Poly-Vi-Sol; Synagis given on 12/17/01
Current Illness: NONE
Preexisting Conditions: Premature at (30 Wk); history of apnea/brady last 12/2/01 with no treatment
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fed poorly at midnight. Slept with mother. Mother found baby cold in mother''s bed when mother awoke. Taken to ER by ambulance. Baby DOA though some resuscitation attempted. COD: complications of prematurity as per autopsy report F/U on 5/22/02, shows changes in the lungs consistent with bronchopulmonary dysplasia with proliferation of the epithelium and uneven opening of the alveolar spaces. The brain is very small; it''s size is more appropriate for a neonate. This may be explained by history of prematurity.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=179926&WAYBACKHISTORY=ON


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