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This is VAERS ID 108127

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108127
VAERS Form:
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX / SMITHKLINE 839A2 / 0 LL / IM
HIBV: ACT-HIB / CONNAUGHT LABS 0909960 / 0 RL / IM
OPV: ORIMUNE / LEDERLE 450848 / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, FEVER, INFECT, STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 12/8/2009

VAERS ID: 108127 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-12 1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: INFANRIX DTAP (INFANRIX) / SMITHKLINE SMITHKLINE BEECHAM 839A2 / 0 LL / IM
HIBV: ACT-HIB HIB (ACTHIB) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0909960 / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 450848 / 0 - / PO

Administered by: Private      Purchased by: Unknown Private
Symptoms: Infection, Pyrexia, SIDS, Stupor, Sudden infant death syndrome, FEVER, INFECT, STUPOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 5/14/2017

VAERS ID: 108127 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 0 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 450848 / 0 - / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 9/14/2017

VAERS ID: 108127 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 0 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 0 1 - MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 2/14/2018

VAERS ID: 108127 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 6/14/2018

VAERS ID: 108127 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 8/14/2018

VAERS ID: 108127 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 9/14/2018

VAERS ID: 108127 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;


Changed on 10/14/2018

VAERS ID: 108127 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:New Jersey
Vaccinated:1998-02-11
Onset:1998-02-15
Submitted:1998-02-27
Entered:1998-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 839A2 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 0909960 / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 450848 / 1 MO / PO

Administered by: Private      Purchased by: Private
Symptoms: Infection, Pyrexia, Stupor, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-15
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:
Current Illness: Gastroenteritis;T102 & diarrhea;
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: positive rotavirus in stool;
CDC 'Split Type':

Write-up: pt exp T102 & diarrhea on 10FEB98;11FEB98 pt afeb, well hydrated & nl PE;pt recv vax & devel fever;17FEB98 pt unresponsive @ 9AM taken to ER found to be dead on arrival autopsy performed dx SIDS;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=108127&WAYBACKHISTORY=ON


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