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This is VAERS ID 108647

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108647
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 0916470 / 1 LL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 0907910 / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD N0652 / 1 LL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, EDEMA LUNG, PHARYNGITIS, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt died less than 24hr p/vax;


Changed on 12/8/2009

VAERS ID: 108647 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-19 1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0916470 / 1 LL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0907910 / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. N0652 / 1 LL / SC

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, SIDS, Sudden infant death syndrome, EDEMA LUNG, PHARYNGITIS, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 5/14/2017

VAERS ID: 108647 Before After
VAERS Form:
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 1 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 LL / SC

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 9/14/2017

VAERS ID: 108647 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 1 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 1 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 2/14/2018

VAERS ID: 108647 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 6/14/2018

VAERS ID: 108647 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 8/14/2018

VAERS ID: 108647 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 9/14/2018

VAERS ID: 108647 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;


Changed on 10/14/2018

VAERS ID: 108647 Before After
VAERS Form:1
Age:0.4
Sex:Male
Location:California
Vaccinated:1998-03-13
Onset:1998-03-14
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 0916470 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907910 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0652 / 2 LL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pharyngitis, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-14
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: Cispride;Nystatin cream
Current Illness: minor candidal neck rash
Preexisting Conditions: choking/desaturation w/feeds-dysmaturity vs reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CA980032

Write-up: pt died less than 24hr p/vax;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=108647&WAYBACKHISTORY=ON


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