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This is VAERS ID 151619

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 151619
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE DTPA919A2 / 0 RL / IM
HBHEPB: COMVAX / MSD 1975J / 0 LL / IM
IPV: IPV / MERIEUX INST R02352 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: FEVER, DIARRHEA, DEHYDRAT, ACIDOSIS, EFFUS PLEURAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acid"osis, hyperkalalemia

Changed on 12/8/2009

VAERS ID: 151619 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM DTPA919A2 919A2 / 0 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1975J / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. R02352 / 0 RL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting, FEVER, DIARRHEA, DEHYDRAT, ACIDOSIS, EFFUS PLEURAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acid"osis, acidosis, hyperkalalemia

Changed on 9/14/2017

VAERS ID: 151619 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 2/14/2018

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 6/14/2018

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 8/14/2018

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 9/14/2018

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 10/14/2018

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 12/24/2020

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

Changed on 12/30/2020

VAERS ID: 151619 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:California
Vaccinated:2000-04-10
Onset:0000-00-00
Submitted:2000-04-26
Entered:2000-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 919A2 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1975J / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R02352 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Acidosis, Cardiac arrest, Cardiac failure, Dehydration, Diarrhoea, Hyperkalaemia, Pleural effusion, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2000-04-17
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:
Current Illness: NONE
Preexisting Conditions: pyeloromyotony, pyloric stenosis
Allergies:
Diagnostic Lab Data: CSFCX-neg, BCX-neg
CDC 'Split Type':

Write-up: Pt experienced vomiting, diarrhea, dehydration. Pt was hospitalized for 20 hours with dehydration. Pt went into cardiac arrest and transferred to ICU where pt continued to arrest and sustained organ failure.Autopsy shows high fever, pleural effusion, acidosis, hyperkalalemia

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=151619&WAYBACKHISTORY=ON


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