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This is VAERS ID 109867

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 109867
VAERS Form:
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 448451 / 0 LL / IM
HEP: ENGERIX-B / SMITHKLINE 2333A2 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M195RC / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD M09391 / 0 RL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: NA
Other Medications: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': unk

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 12/8/2009

VAERS ID: 109867 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 448451 / 0 LL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2333A2 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M195RC / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M09391 / 0 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: NA
Other Medications: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': unk IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 5/14/2017

VAERS ID: 109867 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
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 (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M195RC / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 0 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 9/14/2017

VAERS ID: 109867 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 0 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 0 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 2/14/2018

VAERS ID: 109867 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 6/14/2018

VAERS ID: 109867 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 8/14/2018

VAERS ID: 109867 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 9/14/2018

VAERS ID: 109867 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;


Changed on 10/14/2018

VAERS ID: 109867 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Iowa
Vaccinated:1998-04-14
Onset:0000-00-00
Submitted:1998-04-16
Entered:1998-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 448451 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2333A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M195RC / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M09391 / 1 RL / SC

Administered by: Private      Purchased by: Public
Symptoms: Sudden infant death syndrome

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-15
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: Engerix hep B lot# 2333A2 given 20FEB98;
Current Illness: NONE
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: auutopsy performed;
CDC 'Split Type': IA98010

Write-up: pt recv vax 14APR98 @ approx 1130AM;pt was found dead 15APR98 approx 830AM;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=109867&WAYBACKHISTORY=ON


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