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This is VAERS ID 109562

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 109562
VAERS Form:
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 446834 / 2 RL / IM
HEP: RECOMBIVAX HB / MSD 1036E / 2 LL / IM
OPV: ORIMUNE / LEDERLE 449526 / 2 - / PO

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NKDA/no birth defect/no medical condition

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 12/8/2009

VAERS ID: 109562 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-09 1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 446834 / 2 RL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 446834 / 2 RL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1036E / 2 LL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 449526 / 2 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NKDA/no birth defect/no medical condition (blank)

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 3/14/2017

VAERS ID: 109562 Before After
VAERS Form:
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 446834 / 2 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 449526 / 2 - / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 9/14/2017

VAERS ID: 109562 Before After
VAERS Form:(blank) 1
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 2 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 2 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 2 3 - MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 2/14/2018

VAERS ID: 109562 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 6/14/2018

VAERS ID: 109562 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 8/14/2018

VAERS ID: 109562 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 9/14/2018

VAERS ID: 109562 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 10/14/2018

VAERS ID: 109562 Before After
VAERS Form:1
Age:0.6
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;


Changed on 8/14/2020

VAERS ID: 109562 Before After
VAERS Form:1
Age:0.6 0.58
Sex:Male
Location:Unknown
Vaccinated:1998-02-19
Onset:1998-02-20
Submitted:1998-03-30
Entered:1998-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 446834 / 3 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1036E / 3 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 449526 / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-02-20
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 ()~~0.00~Patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NKDA/no birth defect/no medical condition
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: pt recv multiple vax p/a complete unremarkable well baby visit;observed in clinic for 30min;given APAP prophylactically;discovered the following day dead;autopsy completed COD: unexplained death of infancy SIDS;

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=109562&WAYBACKHISTORY=ON


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