National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 107742

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107742
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7H81507 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 2251A2 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M305NP / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0766H / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, ISCHEMIA CEREBR

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: NA
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NONE

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 12/8/2009

VAERS ID: 107742 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-20 1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7H81507 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 2251A2 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M305NP / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0766H / 0 - / PO

Administered by: Public      Purchased by: Unknown Other
Symptoms: Cerebral ischaemia, SIDS, Sudden infant death syndrome, ISCHEMIA CEREBR

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: NA
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NONE NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 5/14/2017

VAERS ID: 107742 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M305NP / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0766H / 0 - / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 9/14/2017

VAERS ID: 107742 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 0 1 - MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 2/14/2018

VAERS ID: 107742 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 6/14/2018

VAERS ID: 107742 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 8/14/2018

VAERS ID: 107742 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 9/14/2018

VAERS ID: 107742 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;


Changed on 10/14/2018

VAERS ID: 107742 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-01-22
Onset:1998-02-07
Submitted:1998-02-11
Entered:1998-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7H81507 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 2251A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M305NP / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0766H / 1 MO / PO

Administered by: Public      Purchased by: Other
Symptoms: Cerebral ischaemia, Sudden infant death syndrome

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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: rash under neck & face
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC 'Split Type': NC98005

Write-up: death per reporter death certificate states cerebral anoxia & SIDS;

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107742&WAYBACKHISTORY=ON


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