National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 106657

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 106657
VAERS Form:
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7H81507 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE 2292A2 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M195RF / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M0938 / 0 RL / IM

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 12/8/2009

VAERS ID: 106657 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-21 1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7H81507 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2292A2 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M195RF / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0938 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 5/14/2017

VAERS ID: 106657 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 0 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M195RF / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 0 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 9/14/2017

VAERS ID: 106657 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 0 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 2/14/2018

VAERS ID: 106657 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 6/14/2018

VAERS ID: 106657 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 8/14/2018

VAERS ID: 106657 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 9/14/2018

VAERS ID: 106657 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;


Changed on 10/14/2018

VAERS ID: 106657 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:Tennessee
Vaccinated:1997-12-08
Onset:1997-12-09
Submitted:1997-12-09
Entered:1998-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2292A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0938 / 1 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-12-09
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN97055

Write-up: Medical examiner reported pt was pronounced dead @ 136PM 9DEC97;autopsy to be performed;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=106657&WAYBACKHISTORY=ON


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166