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This is VAERS ID 180557

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 180557
VAERS Form:
Age:1.3
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 2/14/2017

VAERS ID: 180557 Before After
VAERS Form:
Age:1.3 1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 0 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 9/14/2017

VAERS ID: 180557 Before After
VAERS Form:(blank) 1
Age:1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 0 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 2/14/2018

VAERS ID: 180557 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 6/14/2018

VAERS ID: 180557 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 8/14/2018

VAERS ID: 180557 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 9/14/2018

VAERS ID: 180557 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.


Changed on 10/14/2018

VAERS ID: 180557 Before After
VAERS Form:1
Age:1.25
Sex:Male
Location:Foreign
Vaccinated:2001-03-06
Onset:0000-00-00
Submitted:2001-12-04
Entered:2002-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 308B0 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 - / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Hyperthermia, Otitis media

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2001-03-09
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:
Allergies:
Diagnostic Lab Data: On an unknown date, an autopsy was performed of which the report is not yet available.
CDC 'Split Type': 20010120602

Write-up: On 3/6/01, the vaccinee received the 1st Engerix-B pediatric together with the 1st Priorix (measles, mumps, rubella vaccine). On a date unknown, the vaccinee developed otitis media with hyperthermia. Three days, post vax, on 3/9/01, the child was found dead in bed. The reporting physician suspected a post vax reaction. In the information received on 5/17/01, the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. A 15-day follow up report received 4/19/2002 adds: One day before vaccination, on 03/05/2001 an ear, nose and throat specialist found fluid in the middle ears. An autopsy was performed and showed that the cause of death was probable prurulent otitis media on both ears with hyperthermia. The pt was obviously vaccinated in a current infection. In the info received on 05/17/2001 the reporter considered that the event was possibly related to treatment with Priorix. The causality of Engerix-B pediatric was not specified. Follow-up info, taken from a publication of PEI (Auswartung der Meldungen von Verdachtsfoellen and Imptkomplikationen nach dem Infektionsachutzgesetz. April 2002) contained the info about fluid __ and the autopsy results. The PEI assessed the event as "unlikely" related.

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