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This is VAERS ID 107132

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107132
VAERS Form:
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 819A2 / 0 - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M200RC / 0 - / IM
OPV: ORIMUNE / LEDERLE 448506 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 12/8/2009

VAERS ID: 107132 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-04 1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 819A2 / 0 - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M200RC / 0 - / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 448506 / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 5/14/2017

VAERS ID: 107132 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 0 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M200RC / 0 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 448506 / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 9/14/2017

VAERS ID: 107132 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 0 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 0 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 2/14/2018

VAERS ID: 107132 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 6/14/2018

VAERS ID: 107132 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 8/14/2018

VAERS ID: 107132 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 9/14/2018

VAERS ID: 107132 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;


Changed on 10/14/2018

VAERS ID: 107132 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:Illinois
Vaccinated:1998-01-05
Onset:1998-01-13
Submitted:1998-01-27
Entered:1998-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 819A2 / 1 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 448506 / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-13
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: awaiting coroner''s report
CDC 'Split Type':

Write-up: sudden death;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107132&WAYBACKHISTORY=ON


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