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This is VAERS ID 108077

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108077
VAERS Form:
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7G81484 / - - / -
HIBV: ACT-HIB / CONNAUGHT LABS - / - - / -
OPV: ORIMUNE / LEDERLE - / - - / PO

Administered by: Other      Purchased by: Unknown
Symptoms: SIDS, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type':

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 12/8/2009

VAERS ID: 108077 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-03-11 1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7G81484 / - - / -
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES - / - - / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES - / - - / PO

Administered by: Other      Purchased by: Unknown Other
Symptoms: Apnoea, SIDS, Sudden infant death syndrome, APNEA

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': (blank) 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 5/14/2017

VAERS ID: 108077 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / - - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / - - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH - / - - / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 9/14/2017

VAERS ID: 108077 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / - UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / - UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / - UNK - MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 2/14/2018

VAERS ID: 108077 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 6/14/2018

VAERS ID: 108077 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 8/14/2018

VAERS ID: 108077 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 9/14/2018

VAERS ID: 108077 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;


Changed on 10/14/2018

VAERS ID: 108077 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Texas
Vaccinated:1997-04-28
Onset:1997-04-28
Submitted:1997-05-09
Entered:1998-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7G81484 / UNK - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / UNK MO / PO

Administered by: Other      Purchased by: Other
Symptoms: Apnoea, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-04-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: autopsy results consistent w/accidental suffocation;
CDC 'Split Type': 897132004L

Write-up: pt recv vax 28APR97 & that afternoon babysitter found pt dead;pt was taken to ER;autopsy results are pending however ER staff attributed this event to SIDS;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=108077&WAYBACKHISTORY=ON


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