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This is VAERS ID 110238

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 110238
VAERS Form:
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA / CONNAUGHT LABS 7L81673 / 1 RL / IM
HIBV: PROHIBIT / CONNAUGHT LABS 7D91716 / 1 RL / IM
IPV: POLIOVAX / CONNAUGHT LTD L1217 / 1 LL / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 12/8/2009

VAERS ID: 110238 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-29 1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: TRIPEDIA DTAP (TRIPEDIA) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7L81673 / 1 RL / IM
HIBV: PROHIBIT HIB (PROHIBIT) / CONNAUGHT LABS CONNAUGHT LABORATORIES 7D91716 / 1 RL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. L1217 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 5/14/2017

VAERS ID: 110238 Before After
VAERS Form:
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 1 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 1 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 9/14/2017

VAERS ID: 110238 Before After
VAERS Form:(blank) 1
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 1 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 1 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 1 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 2/14/2018

VAERS ID: 110238 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 6/14/2018

VAERS ID: 110238 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 8/14/2018

VAERS ID: 110238 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 9/14/2018

VAERS ID: 110238 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;


Changed on 10/14/2018

VAERS ID: 110238 Before After
VAERS Form:1
Age:0.4
Sex:Female
Location:Tennessee
Vaccinated:1998-04-20
Onset:1998-04-21
Submitted:1998-04-21
Entered:1998-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 7L81673 / 2 RL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 7D91716 / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1217 / 2 LL / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-21
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-present for well child check;
Preexisting Conditions: mom tx for group B strep during perinatal period/hx constipation/hemangioma on rt lat heel;
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: pt recv vax 20APR & pt found dead morning of 21APR apparent SIDS;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=110238&WAYBACKHISTORY=ON


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