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This is VAERS ID 108655

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108655
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7C91935 / 1 LL / IM
HEP: ENGERIX-B / SMITHKLINE 2392A2 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M165RH / 1 LL / IM
IPV: IPV / MERIEUX INST M0939 / 1 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, ENCEPHALOPATHY, ANOMALY CONGEN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 12/8/2009

VAERS ID: 108655 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
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 7C91935 / 1 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2392A2 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M165RH / 1 LL / IM
IPV: IPV POLIO VIRUS, INACT. (NO BRAND NAME) / MERIEUX INST PASTEUR MERIEUX INST. M0939 / 1 RL / SC

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Congenital anomaly, Encephalopathy, SIDS, Sudden infant death syndrome, ENCEPHALOPATHY, ANOMALY CONGEN

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 5/14/2017

VAERS ID: 108655 Before After
VAERS Form:
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M165RH / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 1 RL / SC

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 9/14/2017

VAERS ID: 108655 Before After
VAERS Form:(blank) 1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 1 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 1 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 2/14/2018

VAERS ID: 108655 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 6/14/2018

VAERS ID: 108655 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 8/14/2018

VAERS ID: 108655 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 9/14/2018

VAERS ID: 108655 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;


Changed on 10/14/2018

VAERS ID: 108655 Before After
VAERS Form:1
Age:0.3
Sex:Female
Location:North Carolina
Vaccinated:1998-03-12
Onset:1998-03-13
Submitted:1998-03-16
Entered:1998-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7C91935 / 2 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2392A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 2 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. M0939 / 2 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Congenital anomaly, Encephalopathy, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-13
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 13MAR98 pt found deceased in crib 830AM;parents put to bed 11:30PM on 12MAR98;well check up done 12MAR98;all nl findings;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=108655&WAYBACKHISTORY=ON


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