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This is VAERS ID 108072

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108072
VAERS Form:
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 6C81348 / 0 LL / IM
HBHEPB: COMVAX / MSD 1656D / - RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M0443X / - LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, CHILLS, CYANOSIS, HEART ARREST, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type': heart murmur-innocent per clinical exam;laryngomalacia;

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 12/8/2009

VAERS ID: 108072 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-11 1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6C81348 / 0 LL / IM
HBHEPB: COMVAX HIB + HEP B (COMVAX) / MSD MERCK & CO. INC. 1656D / - RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0443X / - LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, SIDS, Stupor, Sudden infant death syndrome, Unevaluable event, CHILLS, CYANOSIS, HEART ARREST, HYPOXIA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type': heart murmur-innocent per clinical exam;laryngomalacia; (blank)

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 5/14/2017

VAERS ID: 108072 Before After
VAERS Form:
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 0 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / - RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / - LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 9/14/2017

VAERS ID: 108072 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 0 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / - UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / - UNK LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 2/14/2018

VAERS ID: 108072 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 6/14/2018

VAERS ID: 108072 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 8/14/2018

VAERS ID: 108072 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 9/14/2018

VAERS ID: 108072 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;


Changed on 10/14/2018

VAERS ID: 108072 Before After
VAERS Form:1
Age:0.1
Sex:Female
Location:New Mexico
Vaccinated:1998-02-23
Onset:1998-02-25
Submitted:1998-03-02
Entered:1998-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6C81348 / 1 LL / IM
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. 1656D / UNK RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0443X / UNK LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: Cardiac arrest, Chills, Cyanosis, Hypoxia, Stupor, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-25
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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: upper resp infect
Preexisting Conditions: heart murmur-innocent per clinical exam;laryngomalacia;
Allergies:
Diagnostic Lab Data: prelim autopsy- gross pathology nl;RSV swab negative;blood & CSF negative;tracheal spiratee cult nl
CDC 'Split Type':

Write-up: pt found blue 2hr p/last feeding;brought to ER pt cold, blue w/rigor present;pt intubated given med but remained asystolic;

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