National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 107087

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107087
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7B81603 / 0 RL / IM
HEP: RECOMBIVAX HB / MSD 0924E / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M200RC / 0 LL / IM
OPV: ORIMUNE / LEDERLE 0767H / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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:
Current Illness: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': NONE

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 12/8/2009

VAERS ID: 107087 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-02-04 1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7B81603 / 0 RL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0924E / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M200RC / 0 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0767H / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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:
Current Illness: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': NONE TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 5/14/2017

VAERS ID: 107087 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 0 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M200RC / 0 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0767H / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 9/14/2017

VAERS ID: 107087 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 0 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 0 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 2/14/2018

VAERS ID: 107087 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 6/14/2018

VAERS ID: 107087 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 8/14/2018

VAERS ID: 107087 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 9/14/2018

VAERS ID: 107087 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;


Changed on 10/14/2018

VAERS ID: 107087 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-01-22
Onset:1998-01-23
Submitted:1998-01-23
Entered:1998-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B81603 / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0924E / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0767H / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: hx of congestion-nl exam x/eczema
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy pending
CDC 'Split Type': TX98011

Write-up: pt found unresponsive less than 24hr p/vax;autopsy pending;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107087&WAYBACKHISTORY=ON


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