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This is VAERS ID 107712

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107712
VAERS Form:
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 826A2 / 2 LL / IM
HEP: RECOMBIVAX HB / MSD 0748E / 2 RL / IM
HIBV: PEDVAXHIB / MSD 0535E / 2 LL / IM
OPV: ORIMUNE / LEDERLE 0772K / 2 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, AGITATION, CHILLS, INSOMNIA, SKIN DISCOLOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 12/8/2009

VAERS ID: 107712 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-19 1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 826A2 / 2 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 0748E / 2 RL / IM
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 0535E / 2 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0772K / 2 - / PO

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Agitation, Chills, Insomnia, SIDS, Skin discolouration, Sudden infant death syndrome, Unevaluable event, AGITATION, CHILLS, INSOMNIA, SKIN DISCOLOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 5/14/2017

VAERS ID: 107712 Before After
VAERS Form:
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 2 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0772K / 2 - / PO

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 9/14/2017

VAERS ID: 107712 Before After
VAERS Form:(blank) 1
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 2 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 2 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 2 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 2 3 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 2/14/2018

VAERS ID: 107712 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 6/14/2018

VAERS ID: 107712 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 8/14/2018

VAERS ID: 107712 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 9/14/2018

VAERS ID: 107712 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;


Changed on 10/14/2018

VAERS ID: 107712 Before After
VAERS Form:1
Age:0.5
Sex:Female
Location:New Mexico
Vaccinated:1998-02-06
Onset:1998-02-07
Submitted:1998-02-09
Entered:1998-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 3 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0748E / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0535E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0772K / 3 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Agitation, Chills, Insomnia, Skin discolouration, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: unk
CDC 'Split Type':

Write-up: pt fussy during noc-up w/pt several times on & off;last check 03:30 went in @ 05:30 or 06:00 @ foot of crib pt found cool & mottled;EMT tried to resuscitate w/no results & again in ER;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107712&WAYBACKHISTORY=ON


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