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This is VAERS ID 108977

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 108977
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 441099 / - LL / -
OPV: ORIMUNE / LEDERLE 0756L / 0 - / PO

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS, APNEA, SLEEP MATERIALS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': preterm 38wk

Write-up: undetermined cause of death;


Changed on 12/8/2009

VAERS ID: 108977 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 441099 / - LL / -
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 441099 / - LL / -
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0756L / 0 - / PO

Administered by: Private      Purchased by: Unknown Public
Symptoms: Apnoea, SIDS, Sudden infant death syndrome, Unevaluable event, APNEA, SLEEP MATERIALS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': preterm 38wk NH97

Write-up: undetermined cause of death;


Changed on 5/14/2017

VAERS ID: 108977 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 441099 / - LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0756L / 0 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;


Changed on 9/14/2017

VAERS ID: 108977 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / - UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 0 1 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;


Changed on 2/14/2018

VAERS ID: 108977 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;


Changed on 6/14/2018

VAERS ID: 108977 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;


Changed on 8/14/2018

VAERS ID: 108977 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;


Changed on 9/14/2018

VAERS ID: 108977 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;


Changed on 10/14/2018

VAERS ID: 108977 Before After
VAERS Form:1
Age:0.2
Sex:Male
Location:New Hampshire
Vaccinated:1997-01-08
Onset:1997-01-22
Submitted:1998-03-01
Entered:1998-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / UNK LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1997-01-22
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: NONE~ ()~~~In patient
Other Medications: pt recv hep B vax 8NOV96;
Current Illness: NONE
Preexisting Conditions: preterm 38wk
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NH97

Write-up: undetermined cause of death;

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