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This is VAERS ID 109218

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 109218
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7B91821 / 0 RL / -
HIBV: PROHIBIT / CONNAUGHT LABS 0907880 / 0 LL / -
IPV: POLIOVAX / CONNAUGHT LTD M1294 / 0 LL / -

Administered by: Private      Purchased by: Unknown
Symptoms: CEREBROVASC DIS, RESPIRAT DIS, ENCEPHALOPATHY, ANOMALY CONGEN, HYDROCEPHALUS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 12/8/2009

VAERS ID: 109218 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-07 1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7B91821 / 0 RL / -
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 0907880 / 0 LL / -
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M1294 / 0 LL / -

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida, CEREBROVASC DIS, RESPIRAT DIS, ENCEPHALOPATHY, ANOMALY CONGEN, HYDROCEPHALUS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 5/14/2017

VAERS ID: 109218 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 0 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 0 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 0 LL / -

Administered by: Unknown Private      Purchased by: Unknown Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 9/14/2017

VAERS ID: 109218 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 0 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 0 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 0 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 2/14/2018

VAERS ID: 109218 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 6/14/2018

VAERS ID: 109218 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 8/14/2018

VAERS ID: 109218 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 9/14/2018

VAERS ID: 109218 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;


Changed on 10/14/2018

VAERS ID: 109218 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-23
Onset:1998-01-23
Submitted:1998-02-20
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7B91821 / 1 RL / -
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0907880 / 1 LL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1294 / 1 LL / -

Administered by: Private      Purchased by: Public
Symptoms: Cerebrovascular disorder, Congenital anomaly, Encephalopathy, Hydrocephalus, Respiratory disorder, Spina bifida

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-23
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: Trimethoprim-sulfa
Current Illness: NONE
Preexisting Conditions: hydrocephalus, chiari malformation myelomeningocele
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98008

Write-up: pt died of suspected SIDS-pt had underlying severe hydrocephalus & chiari malformation was in good baseline hlth was found in prone position pt had very poor tone & head control at baseline;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=109218&WAYBACKHISTORY=ON


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