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This is VAERS ID 107414

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107414
VAERS Form:
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 1611B2 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: AGITATION, APNEA, HEART ARREST, LUNG DIS, CRY ABNORMAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 12/8/2009

VAERS ID: 107414 Before After
VAERS Form:
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-13 1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 1611B2 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting, AGITATION, APNEA, HEART ARREST, LUNG DIS, CRY ABNORMAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 5/14/2017

VAERS ID: 107414 Before After
VAERS Form:
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 9/14/2017

VAERS ID: 107414 Before After
VAERS Form:(blank) 1
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 2/14/2018

VAERS ID: 107414 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 6/14/2018

VAERS ID: 107414 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 8/14/2018

VAERS ID: 107414 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 9/14/2018

VAERS ID: 107414 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 10/14/2018

VAERS ID: 107414 Before After
VAERS Form:1
Age:0.0
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;


Changed on 7/14/2019

VAERS ID: 107414 Before After
VAERS Form:1
Age:0.0 (blank)
Sex:Female
Location:Ohio
Vaccinated:1996-04-03
Onset:0000-00-00
Submitted:1998-02-02
Entered:1998-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1611B2 / UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Agitation, Apnoea, Cardiac arrest, Crying, Lung disorder, Rash, Sudden infant death syndrome, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1996-05-11
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: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden agitation, screams, vomited frequently then died;

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