National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 106935

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 106935
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 447833 / 1 LL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M260R1 / 1 LL / -
IPV: POLIOVAX / CONNAUGHT LTD M01472 / 1 RL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NONE

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 12/8/2009

VAERS ID: 106935 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-27 1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 447833 / 1 LL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M260R1 / 1 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M01472 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type': NONE (blank)

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 5/14/2017

VAERS ID: 106935 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 447833 / 1 LL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M260R1 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 1 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 9/14/2017

VAERS ID: 106935 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 1 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 1 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 1 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 2/14/2018

VAERS ID: 106935 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 6/14/2018

VAERS ID: 106935 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 8/14/2018

VAERS ID: 106935 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 9/14/2018

VAERS ID: 106935 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;


Changed on 10/14/2018

VAERS ID: 106935 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Kentucky
Vaccinated:1998-01-16
Onset:1998-01-17
Submitted:1998-01-23
Entered:1998-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 447833 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260R1 / 2 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M01472 / 2 RL / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-17
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: w/in 24hr SIDS per state;autopsy pending;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=106935&WAYBACKHISTORY=ON


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