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This is VAERS ID 110683

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 110683
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B / SMITHKLINE 2375A2 / 1 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: HYPOKINESIA, STUPOR, HEPATITIS, JAUNDICE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type':

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 12/8/2009

VAERS ID: 110683 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-11 1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: ENGERIX-B HEP B (ENGERIX-B) / SMITHKLINE SMITHKLINE BEECHAM 2375A2 / 1 LA / IM

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor, HYPOKINESIA, STUPOR, HEPATITIS, JAUNDICE

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': (blank) NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 5/14/2017

VAERS ID: 110683 Before After
VAERS Form:
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 1 LA / IM

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 9/14/2017

VAERS ID: 110683 Before After
VAERS Form:(blank) 1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 1 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 2/14/2018

VAERS ID: 110683 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 6/14/2018

VAERS ID: 110683 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 8/14/2018

VAERS ID: 110683 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 9/14/2018

VAERS ID: 110683 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;


Changed on 10/14/2018

VAERS ID: 110683 Before After
VAERS Form:1
Age:0.1
Sex:Male
Location:North Carolina
Vaccinated:1998-04-16
Onset:1998-04-22
Submitted:1998-04-27
Entered:1998-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2375A2 / 2 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Hepatitis, Hypokinesia, Jaundice, Stupor

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1998-04-22
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: jaundiced;
Preexisting Conditions: 35wk gestation, unifocal PVC on night of birth, bradycardia episodes, poor feeding;large spits & wt loss
Allergies:
Diagnostic Lab Data: autopsy
CDC 'Split Type': NC98011

Write-up: mom called clinic p/early lunch & told nurse that hot up this AM 22APR98 & pt was not moving;mom attempted rescue breathing w/no response, pt transported to hosp & is now dead;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=110683&WAYBACKHISTORY=ON


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