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This is VAERS ID 108787

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108787
VAERS Form:
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 446956 / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M260RJ / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M11891 / - - / -

Administered by: Military      Purchased by: Unknown
Symptoms: MENINGITIS, EDEMA BRAIN, HEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 12/8/2009

VAERS ID: 108787 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-24 1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 446956 / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M260RJ / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M11891 / - - / -

Administered by: Military      Purchased by: Unknown Military
Symptoms: Meningitis, Brain oedema, Haemorrhage, MENINGITIS, EDEMA BRAIN, HEM

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 5/14/2017

VAERS ID: 108787 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 446956 / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M260RJ / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / - - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 9/14/2017

VAERS ID: 108787 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / - UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 2/14/2018

VAERS ID: 108787 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 6/14/2018

VAERS ID: 108787 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 8/14/2018

VAERS ID: 108787 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 9/14/2018

VAERS ID: 108787 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;


Changed on 10/14/2018

VAERS ID: 108787 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:North Carolina
Vaccinated:1998-01-28
Onset:1998-01-28
Submitted:1998-03-12
Entered:1998-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 446956 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M260RJ / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M11891 / UNK - / -

Administered by: Military      Purchased by: Military
Symptoms: Meningitis, Brain oedema, Haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-07
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: APAP PRN
Current Illness: cold sx
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient died;COD unk by reporter;

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