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This is VAERS ID 108797

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108797
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2408A2 / 1 RL / -
IPV: POLIOVAX / CONNAUGHT LTD M0461 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 12/8/2009

VAERS ID: 108797 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2408A2 / 1 RL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M0461 / 0 LL / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: SIDS, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 5/14/2017

VAERS ID: 108797 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 0 LL / -

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 9/14/2017

VAERS ID: 108797 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 1 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 0 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 2/14/2018

VAERS ID: 108797 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 6/14/2018

VAERS ID: 108797 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 8/14/2018

VAERS ID: 108797 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 9/14/2018

VAERS ID: 108797 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;


Changed on 10/14/2018

VAERS ID: 108797 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-10-16
Onset:1997-11-10
Submitted:1998-03-19
Entered:1998-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2408A2 / 2 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M0461 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-03-19
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: Respigam Ig given IV 5NOV97;pt recv hep B vax 12SEP97;
Current Illness: NONE
Preexisting Conditions: NKA;no defects;prematurity
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH9732

Write-up: SIDS-6 lbs 3oz @ time of death;

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