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This is VAERS ID 107791

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 107791
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7A81635 / 0 RL / IM
HBHEPB: COMVAX / MSD 2392A2 / 0 LL / IM
IPV: IPV / MERIEUX INST M1070 / 0 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, APNEA, COUGH INC

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 12/8/2009

VAERS ID: 107791 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-24 1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7A81635 / 0 RL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 2392A2 / 0 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. M1070 / 0 LL / SC

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Cough, SIDS, Sudden infant death syndrome, APNEA, COUGH INC

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 5/14/2017

VAERS ID: 107791 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 0 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 0 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 0 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 9/14/2017

VAERS ID: 107791 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 0 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 0 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 2/14/2018

VAERS ID: 107791 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 6/14/2018

VAERS ID: 107791 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 8/14/2018

VAERS ID: 107791 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 9/14/2018

VAERS ID: 107791 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;


Changed on 10/14/2018

VAERS ID: 107791 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Illinois
Vaccinated:1998-01-07
Onset:1998-01-12
Submitted:0000-00-00
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7A81635 / 1 RL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 2392A2 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M1070 / 1 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Cough, Sudden infant death syndrome

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: NONE
Current Illness: URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': IL98008

Write-up: pt saw MD 12JAN98 for persistent cough;MD states pt had no fever or unusual sx on assessment;MD gave rx;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=107791&WAYBACKHISTORY=ON


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