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This is VAERS ID 109219

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 109219
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 6F81445 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 1308D / 1 LL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M200RC / 0 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD M10702 / 0 RL / SC

Administered by: Public      Purchased by: Unknown
Symptoms: SIDS, EDEMA LUNG, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 12/8/2009

VAERS ID: 109219 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-07 1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 6F81445 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1308D / 1 LL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M200RC / 0 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M10702 / 0 RL / SC

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Pulmonary oedema, SIDS, Sudden infant death syndrome, EDEMA LUNG, LUNG DIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NONE TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 5/14/2017

VAERS ID: 109219 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 1 LL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M200RC / 0 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 0 RL / SC

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 9/14/2017

VAERS ID: 109219 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 1 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 0 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 0 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 2/14/2018

VAERS ID: 109219 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 6/14/2018

VAERS ID: 109219 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 8/14/2018

VAERS ID: 109219 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 9/14/2018

VAERS ID: 109219 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;


Changed on 10/14/2018

VAERS ID: 109219 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Tennessee
Vaccinated:1998-01-28
Onset:1998-01-29
Submitted:1998-01-30
Entered:1998-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6F81445 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M200RC / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M10702 / 1 RL / SC

Administered by: Public      Purchased by: Public
Symptoms: Lung disorder, Pulmonary oedema, Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-01-29
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TN98006

Write-up: mom reported that baby died yesterday AM @ some time between 7 & 10AM;pt was in bed w/mom;mom reported she wondered about the shots causing this;however was told by coroner that it was SIDS;reporter unsure whether autopsy done/complete;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=109219&WAYBACKHISTORY=ON


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