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This is VAERS ID 108794

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108794
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 6F8144 / 0 LL / -
HEP: RECOMBIVAX HB / MSD 1690D / 1 RL / -
HIBV: HIBTITER / LEDERLE(PRAXIS) M005PF / 0 RL / -
OPV: ORIMUNE / LEDERLE 0756L / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, CYANOSIS, RASH, APNEA, PALLOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS


Changed on 12/8/2009

VAERS ID: 108794 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6F8144 / 0 LL / -
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1690D / 1 RL / -
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M005PF / 0 RL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0756L / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, SIDS, Sudden infant death syndrome, Unevaluable event, CYANOSIS, RASH, APNEA, PALLOR

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NH9733

Write-up: SIDS


Changed on 5/14/2017

VAERS ID: 108794 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 0 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 1 RL / -
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M005PF / 0 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0756L / 0 - / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS


Changed on 9/14/2017

VAERS ID: 108794 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 0 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 1 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 0 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 0 1 - MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS


Changed on 2/14/2018

VAERS ID: 108794 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS


Changed on 6/14/2018

VAERS ID: 108794 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS


Changed on 8/14/2018

VAERS ID: 108794 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS


Changed on 9/14/2018

VAERS ID: 108794 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS


Changed on 10/14/2018

VAERS ID: 108794 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:New Hampshire
Vaccinated:1997-05-29
Onset:1997-06-07
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F8144 / 1 LL / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1690D / 2 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M005PF / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

Administered by: Private      Purchased by: Public
Symptoms: Apnoea, Cyanosis, Pallor, Rash, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-06-07
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: pt recv hep b vax by MSD lot# 1463D given 4APR97
Current Illness: NONE
Preexisting Conditions: 9MAY97 repair of bilat indirect inguinal hernia, slow weight gain
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9733

Write-up: SIDS

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