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This is VAERS ID 110237

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 110237
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 450739 / 0 - / IM
HEP: ENGERIX-B / SMITHKLINE 250BA2 / 1 - / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M165RH / 0 - / IM
IPV: POLIOVAX / CONNAUGHT LTD M1180 / 0 - / IM

Administered by: Military      Purchased by: Unknown
Symptoms: REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 12/8/2009

VAERS ID: 110237 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-29 1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 450739 / 0 - / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 250BA2 / 1 - / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE PRAXSIS M165RH / 0 - / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M1180 / 0 - / IM

Administered by: Military      Purchased by: Unknown Military
Symptoms: Unevaluable event, REACT UNEVAL

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 5/14/2017

VAERS ID: 110237 Before After
VAERS Form:
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 450739 / 0 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 1 - / IM
HIBV: HIB (HIBTITER) / LEDERLE PRAXSIS PFIZER/WYETH M165RH / 0 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 0 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 9/14/2017

VAERS ID: 110237 Before After
VAERS Form:(blank) 1
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 0 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 1 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 0 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 0 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 2/14/2018

VAERS ID: 110237 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 6/14/2018

VAERS ID: 110237 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 8/14/2018

VAERS ID: 110237 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 9/14/2018

VAERS ID: 110237 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;


Changed on 10/14/2018

VAERS ID: 110237 Before After
VAERS Form:1
Age:0.2
Sex:Female
Location:Nevada
Vaccinated:1998-04-17
Onset:0000-00-00
Submitted:1998-04-20
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450739 / 1 - / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 250BA2 / 2 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M165RH / 1 - / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1180 / 1 - / IM

Administered by: Military      Purchased by: Military
Symptoms: Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-17
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt expired @ 10PM (cause) pending autopsy report;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=110237&WAYBACKHISTORY=ON


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