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This is VAERS ID 109861

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 109861
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 448451 / 0 LL / IM
HEP: RECOMBIVAX HB / MSD 1038E / 1 RL / IM
HIBV: PEDVAXHIB / MSD 1511E / 0 RL / IM
OPV: ORIMUNE / LEDERLE 0776A / 0 - / PO

Administered by: Public      Purchased by: Unknown
Symptoms: APNEA, EPISTAXIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
CDC 'Split Type': NONE

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 12/8/2009

VAERS ID: 109861 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 448451 / 0 LL / IM
HEP: RECOMBIVAX HB HEP B (RECOMBIVAX HB) / MSD MERCK & CO. INC. 1038E / 1 RL / IM
HIBV: PEDVAXHIB HIB (PEDVAXHIB) / MSD MERCK & CO. INC. 1511E / 0 RL / IM
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0776A / 0 - / PO

Administered by: Public      Purchased by: Unknown Public
Symptoms: Apnoea, Epistaxis, APNEA, EPISTAXIS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
CDC 'Split Type': NONE TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 5/14/2017

VAERS ID: 109861 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 448451 / 0 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 1 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 0 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0776A / 0 - / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 9/14/2017

VAERS ID: 109861 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 0 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 1 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 0 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 0 1 - MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 2/14/2018

VAERS ID: 109861 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 6/14/2018

VAERS ID: 109861 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 8/14/2018

VAERS ID: 109861 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 9/14/2018

VAERS ID: 109861 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;


Changed on 10/14/2018

VAERS ID: 109861 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Texas
Vaccinated:1998-04-14
Onset:1998-04-14
Submitted:1998-04-15
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1038E / 2 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1511E / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0776A / 1 MO / PO

Administered by: Public      Purchased by: Public
Symptoms: Apnoea, Epistaxis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-14
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': TX98061

Write-up: mom states no unusual sx p/shots;no fever, not fussy;put to bed @ 745PM; 840PM father found pt not breathing w/blood in nares;transported by EMS, CPR done, pt DOA @ hosp;

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