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This is VAERS ID 107790

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107790
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7L81673 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M195RF / 1 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0146 / 1 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: INFECT, APNEA, DYSPNEA, PNEUMONIA, PNEUMOTHORAX

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 12/8/2009

VAERS ID: 107790 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-24 1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M195RF / 1 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0146 / 1 LA / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome, INFECT, APNEA, DYSPNEA, PNEUMONIA, PNEUMOTHORAX

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 5/14/2017

VAERS ID: 107790 Before After
VAERS Form:
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M195RF / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 1 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 9/14/2017

VAERS ID: 107790 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 1 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 2/14/2018

VAERS ID: 107790 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 6/14/2018

VAERS ID: 107790 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 8/14/2018

VAERS ID: 107790 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 9/14/2018

VAERS ID: 107790 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;


Changed on 10/14/2018

VAERS ID: 107790 Before After
VAERS Form:1
Age:0.3
Sex:Male
Location:Arizona
Vaccinated:1998-02-09
Onset:0000-00-00
Submitted:1998-02-16
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RF / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0146 / 2 LA / SC

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Dyspnoea, Infection, Pneumonia, Pneumothorax, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-11
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: RAV OTC OM
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired presumed SIDS 56hr p/vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107790&WAYBACKHISTORY=ON


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