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This is VAERS ID 133420

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 133420
VAERS Form:
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 467008 / 0 LL / IM
HIBV: PEDVAXHIB / MSD 0954J / 0 RL / IM
IPV: IPV / MERIEUX INST P03572 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: APNEA, DYSPNEA, BONE DIS, BIRTH PREMAT, HYPOXIA

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 12/8/2009

VAERS ID: 133420 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-27 2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 467008 / 0 LL / IM
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0954J / 0 RL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. P03572 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder, APNEA, DYSPNEA, BONE DIS, BIRTH PREMAT, HYPOXIA

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 5/14/2017

VAERS ID: 133420 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 467008 / 0 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 0 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 9/14/2017

VAERS ID: 133420 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 0 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 0 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 2/14/2018

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 6/14/2018

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 8/14/2018

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 9/14/2018

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 10/14/2018

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 12/24/2020

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.


Changed on 12/30/2020

VAERS ID: 133420 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Michigan
Vaccinated:2000-01-07
Onset:2000-01-07
Submitted:2000-01-10
Entered:2000-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 467008 / 1 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0954J / 1 RL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. P03572 / 1 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: Apnoea, Bone disorder, Dyspnoea, Hypoxia, Pneumonia, Premature labour, Respiratory disorder

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: calcium carbonate, vts D, Poly-vi-sol, Feinsol
Current Illness: NONE
Preexisting Conditions: premature,apnea,osteopenia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breath holding w/ 2nd vax. Spont resp after few sec. Breath holding episode w/ 3rd inject, turned husky-1 hr. No resp approx 3 min. Spont resp started w/ O2. Admit to hosp. Pt suctioned. Discharged & readmit-viral pneumonia. Placed on vent.

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