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This is VAERS ID 110675

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 110675
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE / LEDERLE 450639 / 0 RL / IM
HEP: ENGERIX-B / SMITHKLINE 2404A2 / 1 RL / IM
HIBV: HIBTITER / LEDERLE(PRAXIS) M285RJ / 0 LL / IM
IPV: POLIOVAX / CONNAUGHT LTD M1163 / 0 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: SIDS

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: unk
Other Medications: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type': NONE

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 12/8/2009

VAERS ID: 110675 Before After
VAERS Form:
Age:0.2
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-11 1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: ACEL-IMUNE DTAP (ACEL-IMUNE) / LEDERLE LEDERLE LABORATORIES 450639 / 0 RL / IM
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2404A2 / 1 RL / IM
HIBV: HIBTITER HIB (HIBTITER) / LEDERLE(PRAXIS) LEDERLE LABORATORIES M285RJ / 0 LL / IM
IPV: POLIOVAX POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD CONNAUGHT LTD. M1163 / 0 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: unk
Other Medications: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type': NONE (blank)

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 2/14/2017

VAERS ID: 110675 Before After
VAERS Form:
Age:0.2 0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES 450639 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES M285RJ / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 0 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 5/14/2017

VAERS ID: 110675 Before After
VAERS Form:
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 450639 / 0 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / LEDERLE LABORATORIES PFIZER/WYETH M285RJ / 0 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 0 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 9/14/2017

VAERS ID: 110675 Before After
VAERS Form:(blank) 1
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 0 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 1 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 0 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 0 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 2/14/2018

VAERS ID: 110675 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 6/14/2018

VAERS ID: 110675 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 8/14/2018

VAERS ID: 110675 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 9/14/2018

VAERS ID: 110675 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;


Changed on 10/14/2018

VAERS ID: 110675 Before After
VAERS Form:1
Age:0.17
Sex:Male
Location:California
Vaccinated:1998-03-24
Onset:1998-04-04
Submitted:1998-05-06
Entered:1998-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 450639 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2404A2 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. M1163 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-04
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: pt recv pneumo study vax on 24MAR98 by Lederle, lot# B110
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk what tests were ordered;
CDC 'Split Type':

Write-up: pt recv vax 24MAR98 & pt died from SIDS 4APR98 presented @ hosp;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=110675&WAYBACKHISTORY=ON


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